Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 36050 | CA |
NPI | 1093974255 |
---|---|
Provider Name | Shahriyar Banihashemi |
First Address | Toluca Lake, CA 91602-2563 |
Second Address | Toluca Lake, CA 91602-2563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |