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General NPI Number Information
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NPI Number | 1992981054
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Entity Type | Individual
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Provider Name | AFSHIN SHAMAIZADEH DDS
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Gender | Male
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 10826 VENICE BLVD #101
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City | CULVER CITY
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State | CA
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Zip | 90232
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Country | US
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Telephone | 310-202-0033
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Fax | 310-202-6586
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Provider Business Mailing Address
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Address Line | 10826 VENICE BLVD #101
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City | CULVER CITY
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State | CA
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Zip | 90232
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Country | US
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Telephone | 310-202-0033
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Fax | 310-202-6586
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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 | 58748
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053520
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License Number State | NY
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