Individual
DR. JONATHAN R. SHADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12300 WILSHIRE BLVD, STE 326, LOS ANGELES, CA 90025
(310) 954-9449
(310) 954-9470
Mailing address
12300 WILSHIRE BLVD, STE 326, LOS ANGELES, CA 90025-1020
(310) 954-9449
(310) 954-9470
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
58812
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
58812
CA
Other
Enumeration date
06/02/2009
Last updated
09/23/2024
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