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General NPI Number Information
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NPI Number | 1316139843
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Entity Type | Organization
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Legal Business Name | SHAHRAM HOSSEINI, DDS, INC.
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 1240 SOUTH WESTLAKE BLVD. SUITE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1990
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Country | US
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Telephone | 805-495-7212
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Fax | 805-230-9218
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Provider Business Mailing Address
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Address Line | 1240 SOUTH WESTLAKE BLVD. SUITE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1990
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Country | US
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Telephone | 805-495-7212
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Fax | 805-230-9218
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MR. SHAHRAM HOSSEINI
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Credential | D.D.S
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Telephone | 805-495-7212
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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 | 53068
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License Number State | CA
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