Provider Demographics
NPI:1356939136
Name:BAHADURJI, SHIRIN YEZDI
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:YEZDI
Last Name:BAHADURJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 HILGARD AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3184
Mailing Address - Country:US
Mailing Address - Phone:310-806-1327
Mailing Address - Fax:
Practice Address - Street 1:3861 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4605
Practice Address - Country:US
Practice Address - Phone:310-806-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013518A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist