Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D29996 | CA |
NPI | 1104934983 |
---|---|
Provider Name | Dr. Shariar Shaun Daneshgar |
First Address | Los Angeles, CA 90048 |
Second Address | Los Angeles, CA 90048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001293 | DELTA PMI (01) | CA |
056475 | UNITED CONCORDIA (01) | CA |
B2999601 | (05) | CA |
T09040 | (02) |