MEDICARE: AYA ALSHAFI 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	1223G0001X	General Practice Dentistry	DEN00205863	CO

General Provider Information

NPI Number	:	1275395725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYA ALSHAFI DDS

Provider Business Mailing Address
First Line	:	PO BOX 15667
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-0667
Country	:	US
Telephone Number	:	214-609-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	339 BLUE CAVERN PT
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-6813
Country	:	US
Telephone Number	:	214-609-9040
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	11/18/2025

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