Individual provider Active NPI

Shariar Shaun Daneshgar

  • Oral and Maxillofacial Surgery (Dentist)
  • Los Angeles, CA
National Provider Identifier
1104934983
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D29996 Issued in CA
Practice address
6360 Wilshire Blvd
Suite 403
Los Angeles, CA 90048
Phone
(323) 653-9440
Fax
(323) 653-3586
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D29996 CA Primary

Addresses

Primary practice location

6360 Wilshire Blvd
Suite 403
Los Angeles, CA 90048

Mailing address

6360 Wilshire Blvd
Suite 403
Los Angeles, CA 90048
Phone (323) 653-9440

Other identifiers 3

IdentifierTypeStateIssuer
001293OtherCADELTA PMI
B2999601MedicaidCA
056475OtherCAUNITED CONCORDIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120319000153 CA Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 8527227198 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Tufts University School of Dental Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6360 Wilshire Blvd
Suite 403
Los Angeles, CA 90048-5606
Phone (323) 653-9440

Hospital & facility affiliations

  • Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D29996CAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
S Shaun Daneshgar DMD Inc Current Accepting new patients
S. Shaun Daneshgar DMD Inc CurrentSince Apr 6, 2020 Accepting new patients
S. Shaun Daneshgar DMD Inc Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Southern California Healthcare System, Inc Past Accepting new patients

Locations

2771 E Florence Ave
Huntington Park, CA 90255
Phone (323) 582-1414

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1104934983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 403",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "323-653-9440",
            "fax_number": "323-653-3586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 403",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90048",
            "telephone_number": "323-653-9440",
            "fax_number": "323-653-3586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANESHGAR",
        "first_name": "SHARIAR",
        "middle_name": "SHAUN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "D29996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA PMI",
            "identifier": "001293",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B2999601",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "056475",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.