Wilshire Oral Surgery & Implant Center

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

63560 Issued in CA

Legal business name

WILSHIRE ORAL SURGERY & IMPLANT CENTER

Practice address

12300 Wilshire Blvd
Suite #326
Los Angeles, CA 90025-1020

Phone

(310) 652-6553

Fax

(310) 652-6553

NPI assigned

Dec 8, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Shadi, DDS

Title

President

Phone

(310) 652-6553

Specialties & licenses 2

Addresses

Other names 1

• Jonathan Shadi, DDS, Inc Other name

Locations

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

{
    "created_epoch": "1481155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1205370319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 WILSHIRE BLVD",
            "address_2": "SUITE #326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251020",
            "telephone_number": "310-652-6553",
            "fax_number": "310-652-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 WILSHIRE BLVD",
            "address_2": "SUITE #326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251020",
            "telephone_number": "310-652-6553",
            "fax_number": "310-652-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE ORAL SURGERY & IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-08",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "SHADI",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-652-6553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "58812",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "63560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonathan Shadi, DDS, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; 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.