Provider Demographics
NPI:1215625959
Name:SHIRALI, JAMILEH TAJ (DDS , DMD)
Entity type:Individual
Prefix:
First Name:JAMILEH
Middle Name:TAJ
Last Name:SHIRALI
Suffix:
Gender:F
Credentials:DDS , DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25662 AURORA WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25662 AURORA WAY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4619
Practice Address - Country:US
Practice Address - Phone:714-403-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch