Shahin Mahallati, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

43194 Issued in CA

Practice address

653 Camino de Los Mares Ste 113
San Clemente, CA 92673-2856

Phone

(949) 248-7772

Fax

(949) 248-0516

NPI assigned

Nov 3, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Shahin Mahallati Dental Corp

  dba Smile San Clemente

  • General Practice Dentistry
  • San Clemente, CA
  • NPI 1962043919
  NPD Authorized official
• Sachiko Fukuman, DDS Inc

  • General Practice Dentistry
  • San Clemente, CA
  • NPI 1336279702
  NPD (past)

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1487931598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 113",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732856",
            "telephone_number": "949-248-7772",
            "fax_number": "949-248-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 CAMINO DE LOS MARES STE 113",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732856",
            "telephone_number": "949-248-7772",
            "fax_number": "949-248-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHALLATI",
        "first_name": "SHAHIN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-03",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "43194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Arriola Mabulay
• Vanessa Macias, LMT, LE, HHP
• Kelly Christine Macleod
• Anne Magdits
• Barb Mager, NBC-HWC
• Tala Majaj, PA
• Joel Mallams
• Ashley Mancino, SLPA
• Andrea Rebecca Manghiuc
• Katie B Mann, LCSW

• General Practice Dentistry in San Clemente, CA
• Providers in San Clemente, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; 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.