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General NPI Number Information
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NPI Number | 1942358965
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Entity Type | Individual
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Provider Name | SHAY BYRON DEAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 4832 LINCOLN BLVD
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City | MARINA DEL REY
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State | CA
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Zip | 90292
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Country | US
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Telephone | 310-482-6910
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Fax | 310-496-0252
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Provider Business Mailing Address
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Address Line | 2200 NORTH MAYFAIR ROAD SUITE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-2252
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Country | US
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Telephone | 414-258-9511
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Fax | 414-607-3948
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | A96010
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License Number State | CA
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