MEDICARE: SHAAN BAIG DDS

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	122300000X	Dentist	101118	CA

General Provider Information

NPI Number	:	1255860722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAAN BAIG DDS

Provider Business Mailing Address
First Line	:	4519 LOS FELIZ BLVD APT 309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2078
Country	:	US
Telephone Number	:	248-763-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	6318 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4102
Country	:	US
Telephone Number	:	323-588-4869
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	06/08/2017

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