Provider Demographics
NPI:1780566968
Name:AL SHIKHLY, MINA
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:AL SHIKHLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 MOLINO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4827
Mailing Address - Country:US
Mailing Address - Phone:602-384-0943
Mailing Address - Fax:
Practice Address - Street 1:13334 LIMONITE AVE STE 120
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-7257
Practice Address - Country:US
Practice Address - Phone:951-228-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS111789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist