Provider Demographics
NPI:1801674163
Name:SHAKHSHIR, RENE YASER HIJJAWI (DDS)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:YASER HIJJAWI
Last Name:SHAKHSHIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N BUSHNELL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-8002
Mailing Address - Country:US
Mailing Address - Phone:310-254-7447
Mailing Address - Fax:
Practice Address - Street 1:440 E HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3750
Practice Address - Country:US
Practice Address - Phone:626-447-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1094481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice