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Licensing details for: 105572

Name: BAYANI, SHAHIN

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Address of Record

11312 Farlin St
A1008
LOS ANGELES CA 90049-3014
LOS ANGELES county
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Issuance Date

September 24, 2020

Expiration Date

December 31, 2026

Current Date / Time

June 7, 2025
5:20:27 AM

License Relationships

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: EVERGREEN DENTAL AND ORTHODONTICS DENTAL PRACTICE OF BAYANI POUR DENTAL PARTNERSHIP

License/Registration Type: Fictitious Name Permit

License Number: 18233 Primary Status: Current - Active

Address :
17130 VENTURA BLVD., SUITE 150
ENCINO CA 91316
LOS ANGELES COUNTY

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FNP to DDS or OMS

License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Related Party Role: Fictitious Name Permit

Name: EVERGREEN DENTAL AND ORTHODONTICS DENTAL PRACTICE OF BAYANI POUR DENTAL PARTNERSHIP

License/Registration Type: Fictitious Name Permit

License Number: 18233 Primary Status: Current - Active

Address :
17130 VENTURA BLVD., SUITE 150
ENCINO CA 91316
LOS ANGELES COUNTY

Map

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