MEDICARE: DR. DANNY SHIRI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	35451	CA
2	1223G0001X	General Practice Dentistry	35451	CA

General Provider Information

NPI Number	:	1184760852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY SHIRI D.D.S.

Provider Business Mailing Address
First Line	:	6310 SAN VICENTE BLVD STE 295
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5454
Country	:	US
Telephone Number	:	323-936-9102
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320 COMMODORE SLOAT DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5444
Country	:	US
Telephone Number	:	323-936-9102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/26/2020

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