Aida Shadrav, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

108909 Issued in CA

Practice address

714 Tiverton Ave
Los Angeles, CA 90095-8361

Phone

(310) 825-9789

NPI assigned

Jul 6, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1114598646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 TIVERTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958361",
            "telephone_number": "310-825-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 TIVERTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958361",
            "telephone_number": "310-825-9789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 N Nellis Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891100052",
            "country_code": "US",
            "telephone_number": "702-605-9120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADRAV",
        "first_name": "AIDA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "S6-229C",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "108909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Henry Houshang Shadman, D.D.S.
• Parastoo Shadmani, RD
• Jason Jacob Shadpour, DDS
• Joseph Matthew Shadpour, DO
• Sadaf Shadpour
• Sonya Shadravan
• Doris Shadrooz, PT
• Sydney Rae Shaevel, MFT
• Shafa Physical Therapy, Sport Injury and Rehabilitation Center, Inc.
• Bob Babak Shafa, MD

• Pediatric Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.