Individual
SHAHAB PARSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12420 VENICE BLVD, LOS ANGELES, CA 90066-3840
(310) 482-3910
Mailing address
13273 FIJI WAY APT 432, MARINA DEL REY, CA 90292-7096
(949) 466-3157
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029967
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DDS101386
CA
Other
Enumeration date
10/25/2014
Last updated
07/21/2022
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