Provider Demographics
NPI:1871691394
Name:HOSSEINI, SHAHRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHAHRAM
Other - Middle Name:
Other - Last Name:HOSSEINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1240 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1929
Mailing Address - Country:US
Mailing Address - Phone:805-230-9212
Mailing Address - Fax:805-230-9218
Practice Address - Street 1:1240 S WESTLAKE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-230-9212
Practice Address - Fax:805-230-9218
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice