Jonathan R. Shadi, D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

58812 Issued in CA

Practice address

12300 Wilshire Blvd
Ste 326
Los Angeles, CA 90025

Phone

(310) 954-9449

Fax

(310) 954-9470

NPI assigned

Jun 2, 2009

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Aug 4, 2014 through Aug 4, 2026

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• The Regents of the University of California

  dba UCLA Plastic SUrgery Associates

  • Plastic Surgery Physician
  • Los Angeles, CA
  • NPI 1164487518
  NPD (past)

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1528294709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 WILSHIRE BLVD",
            "address_2": "STE 326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251020",
            "telephone_number": "310-954-9449",
            "fax_number": "310-954-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 WILSHIRE BLVD",
            "address_2": "STE 326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90025",
            "telephone_number": "310-954-9449",
            "fax_number": "310-954-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADI",
        "first_name": "JONATHAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "58812",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "58812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Shaddox, MD, PHD
• Pamela L Shade, CRNA
• Candice Rebecca Shadgoo, DPT
• Shadi Medical Corporation
• Ashkan Rafael Shadi, LMFT
• Payam Shadi, M.D.
• Shadle Chiropractic Prof. Corp.
• Henry Houshang Shadman, D.D.S.
• Parastoo Shadmani, RD
• Jason Jacob Shadpour, DDS

• Oral & Maxillofacial Surgery (D.M.D.) in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.