MEDICARE: NEDA SHAFAI DDS INC

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

General Provider Information

NPI Number	:	1659131506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEDA SHAFAI DDS INC

Provider Business Mailing Address
First Line	:	11922 GORHAM AVE APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5359
Country	:	US
Telephone Number	:	310-877-2648
Fax Number	:

Provider Business Practice Location Address
First Line	:	11922 GORHAM AVE APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5359
Country	:	US
Telephone Number	:	310-877-2648
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	NEDA SHAFAI
Credential	:	DDS
Telephone Number	:	310-877-2648

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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