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Individual
SHADI KAMYAB-KHORASANI
Active
Individual
SHADI KAMYAB-KHORASANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS42557
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS42557
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
03/07/2021
Last updated
03/07/2021
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