Provider Demographics
NPI:1174953517
Name:S YASHARI DDS INC
Entity type:Organization
Organization Name:S YASHARI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:YASHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-770-8074
Mailing Address - Street 1:10417 LOUISIANA AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6069
Mailing Address - Country:US
Mailing Address - Phone:310-770-8074
Mailing Address - Fax:
Practice Address - Street 1:13109 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4416
Practice Address - Country:US
Practice Address - Phone:310-973-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty