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General NPI Number Information
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NPI Number | 1902484389
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Entity Type | Individual
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Provider Name | SHAHE DISHAKJIAN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD STE 820
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City | ENCINO
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State | CA
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Zip | 91436-4394
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Country | US
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Telephone | 818-990-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD STE 820
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City | ENCINO
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State | CA
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Zip | 91436-4394
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Country | US
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Telephone | 818-990-5500
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 106712
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License Number State | CA
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