MEDICARE: DR. SHAHRIYAR BEHJOU DDS, MSC

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	41352	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41352	OTHER	CA	CALIFORNIA DENTAL LICENS
2	G-9149701	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1326174236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRIYAR BEHJOU DDS, MSC

Provider Business Mailing Address
First Line	:	831 S GRETNA GREEN WAY
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5268
Country	:	US
Telephone Number	:	310-826-0151
Fax Number	:	626-448-2040

Provider Business Practice Location Address
First Line	:	10755 LOWER AZUSA RD
Second Line	:	#B
City	:	EL MONTE
State	:	CA
Zip	:	91731-1300
Country	:	US
Telephone Number	:	626-448-2040
Fax Number	:	626-448-9535

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	03/07/2023

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