MEDICARE: DR. JOSHUA BEHNAM SHAYEFAR DMD

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	11775	CT
2	1223P0300X	Periodontics	103757	CA

General Provider Information

NPI Number	:	1346780715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA BEHNAM SHAYEFAR DMD

Provider Business Mailing Address
First Line	:	432 S SAN VICENTE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4192
Country	:	US
Telephone Number	:	310-895-8362
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E 3RD ST STE 1008
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-1648
Country	:	US
Telephone Number	:	213-625-7141
Fax Number	:

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

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	09/05/2019

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