Active NPI
Shahram Mashadian, DDS, MD
- Plastic and Reconstructive Surgery Physician
- Victorville, CA
National Provider Identifier
1811107709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- A96072
- Practice address
- 12640 Hesperia Rd Ste a
Victorville, CA 92395-7753 - Phone
- (760) 241-3336
- NPI assigned
- May 22, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | OMS69 | CA | |
| Plastic and Reconstructive Surgery Physician | 2086S0122X | A96072 | CA | Primary |
Addresses
Primary practice location
12640 Hesperia Rd Ste a
Victorville, CA 92395-7753
Mailing address
12640 Hesperia Rd Ste a
Victorville, CA 92395-7753
Phone (760) 241-3336
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OMS69 | CA | MD | Oral and Maxillofacial Pathology Dentist |
| A96072 | CA | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1811107709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12640 HESPERIA RD STE A",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923957753",
"telephone_number": "760-241-3336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12640 HESPERIA RD STE A",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923957753",
"telephone_number": "760-241-3336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASHADIAN",
"first_name": "SHAHRAM",
"credential": "DDS, MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "CA",
"license": "OMS69",
"primary": false
},
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "CA",
"license": "A96072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.