Provider Demographics
NPI:1104934983
Name:DANESHGAR, SHARIAR SHAUN
Entity type:Individual
Prefix:DR
First Name:SHARIAR
Middle Name:SHAUN
Last Name:DANESHGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:323-653-9440
Mailing Address - Fax:323-653-3586
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-653-9440
Practice Address - Fax:323-653-3586
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD299961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001293OtherDELTA PMI
CAB2999601Medicaid
CA056475OtherUNITED CONCORDIA
CAB2999601Medicaid
T09040Medicare ID - Type Unspecified