Provider Demographics
NPI:1154949709
Name:MEMARIAN, SHAYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:
Last Name:MEMARIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 GREENFIELD AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4416
Mailing Address - Country:US
Mailing Address - Phone:612-562-2628
Mailing Address - Fax:
Practice Address - Street 1:1690 E GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3700
Practice Address - Country:US
Practice Address - Phone:805-552-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist