Active NPI
Henry Shafajoo
- General Practice Dentistry
- South Gate, CA
National Provider Identifier
1720156060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 42607
- Practice address
- 2639 Santa Ana St
South Gate, CA 90280-2025 - Phone
- (323) 583-1481
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 42607 | CA | Primary |
Addresses
Primary practice location
2639 Santa Ana St
South Gate, CA 90280-2025
Mailing address
PO Box 5256
Beverly Hills, CA 90209-5256
Phone (310) 650-9003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42607 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434067200000",
"number": "1720156060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5256",
"city": "BEVERLY HILLS",
"state": "CA",
"postal_code": "902095256",
"telephone_number": "310-650-9003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2639 SANTA ANA ST",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "902802025",
"telephone_number": "323-583-1481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFAJOO",
"first_name": "HENRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2015-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "42607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.