Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 49995 | CA |
NPI | 1013035849 |
---|---|
Provider Name | Michael Shirvani |
First Address | Burbank, CA 91502-1311 |
Second Address | Burbank, CA 91502-1311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |