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General NPI Number Information
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NPI Number | 1275295412
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Entity Type | Individual
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Provider Name | SHAYAN NIAKI DDS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 8116 CALIFORNIA AVE STE C
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City | SOUTH GATE
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State | CA
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Zip | 90280-2400
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Country | US
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Telephone | 323-567-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 11420 SANTA MONICA BLVD #252444
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City | LOS ANGELES
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State | CA
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Zip | 90025-9998
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Country | US
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Telephone | 818-305-4660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 107005
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License Number State | CA
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