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General NPI Number Information
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NPI Number | 1275714552
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Entity Type | Individual
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Provider Name | OMID SHAYAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 9922 WALKER ST STE C
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City | CYPRESS
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State | CA
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Zip | 90630-3097
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Country | US
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Telephone | 714-220-0354
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Fax | 714-220-0427
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Provider Business Mailing Address
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Address Line | 9922 WALKER ST STE C
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City | CYPRESS
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State | CA
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Zip | 90630-3097
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Country | US
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Telephone | 714-220-0354
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Fax | 714-220-0427
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 45408
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License Number State | CA
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