Individual
DR. SHADROUZ KIANOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MAGD
Contact information
Practice address
250 N SEE VEE LN, BISHOP, CA 93514-8130
(760) 873-3443
(760) 503-0205
Mailing address
250 N SEE VEE LN, BISHOP, CA 93514-8130
(760) 873-3443
(760) 503-0205
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
51177
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659433191
EMPLOYER NPI
CA
05
—
THP11576F
—
CA
Enumeration date
01/16/2007
Last updated
08/03/2022
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