Provider Demographics
NPI:1487799227
Name:SHOFFET-YAGHOUBIAN, ROYA (DDS,DMD)
Entity type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:SHOFFET-YAGHOUBIAN
Suffix:
Gender:F
Credentials:DDS,DMD
Other - Prefix:DR
Other - First Name:ROYA
Other - Middle Name:SHOFFET
Other - Last Name:YAGHOUBIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS,DMD
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 208
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4007
Mailing Address - Country:US
Mailing Address - Phone:818-334-6655
Mailing Address - Fax:818-598-8673
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 208
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4007
Practice Address - Country:US
Practice Address - Phone:818-334-6655
Practice Address - Fax:818-598-8673
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40043-01Medicaid