Provider Demographics
NPI:1699242834
Name:DR SHAHOVEISI INC
Entity type:Organization
Organization Name:DR SHAHOVEISI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHOVEISI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-737-3746
Mailing Address - Street 1:161 N MCKINLEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6530
Mailing Address - Country:US
Mailing Address - Phone:951-737-3746
Mailing Address - Fax:951-339-9139
Practice Address - Street 1:161 N MCKINLEY ST STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6530
Practice Address - Country:US
Practice Address - Phone:951-737-3746
Practice Address - Fax:951-339-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental