=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851249536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHADI HAYKANI DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2026
-----------------------------------------------------
Last Update Date | 03/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25385 WAYNE MILLS PL
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-817-9749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4926 TEXHOMA AVE
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91316-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-817-9749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHADI HAYKANI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-817-9749
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------