MEDICARE: ALI SHOJANIA 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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1962179036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI SHOJANIA DDS INC

Provider Business Mailing Address
First Line	:	5927 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2711
Country	:	US
Telephone Number	:	858-922-3762
Fax Number	:	858-225-0410

Provider Business Practice Location Address
First Line	:	5927 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2711
Country	:	US
Telephone Number	:	858-922-3762
Fax Number	:	858-225-0410

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALI SHOJANIA
Credential	:	DDS
Telephone Number	:	858-922-3762

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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