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1357 E Los Angeles Ave Ste C1 Simi Valley CA 93065-2805 | |
| (805) 433-9117 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1357 E Los Angeles Ave Ste C1, Simi Valley, California |
| Authorized Official Name and Position | Kamran Shahsavari (PRESIDENT) |
| Authorized Official Contact | 8054339117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1357 E Los Angeles Ave Ste C1 Simi Valley CA 93065-2805 Ph: (805) 433-9117 | 1357 E Los Angeles Ave Ste C1 Simi Valley CA 93065-2805 Ph: (805) 433-9117 |
| NPI Number | 1477930063 |
|---|---|
| Provider Enumeration Date | 05/03/2015 |
| Last Update Date | 05/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477930063 | NPI | - | NPPES |
| 1841485877 | Other | CA | 1-INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 55980 (California) | Primary |
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