Provider Demographics
NPI:1083124093
Name:BAYANI, SHAHIN (ORTHODONTIST)
Entity type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:BAYANI
Suffix:
Gender:M
Credentials:ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 WILSHIRE BLVD APT A1008
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6536
Mailing Address - Country:US
Mailing Address - Phone:310-435-6058
Mailing Address - Fax:
Practice Address - Street 1:20700 AVALON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3701
Practice Address - Country:US
Practice Address - Phone:617-335-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics