MEDICARE: SHAHED ELHAMDANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	A200569	CA

General Provider Information

NPI Number	:	1306343397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHED ELHAMDANI MD

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 S SAN VICENTE BLVD STE 901
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4174
Country	:	US
Telephone Number	:	310-423-9678
Fax Number	:	310-248-7399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2018
Last Update Date	:	04/13/2026

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