MEDICARE: DR. SHAHRAM DANESHGAR 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	207R00000X	Internal Medicine Physician	A33755	CA
2	207RI0008X	Hepatology Physician	A33755	CA
3	207RG0100X	Gastroenterology Physician	A33755	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730191875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRAM DANESHGAR MD

Provider Business Mailing Address
First Line	:	2230 LYNN RD STE 300
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1991
Country	:	US
Telephone Number	:	805-371-8400
Fax Number	:	805-371-8404

Provider Business Practice Location Address
First Line	:	2230 LYNN RD
Second Line	:	SUITE 300
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-8010
Country	:	US
Telephone Number	:	805-371-8400
Fax Number	:	805-371-8404

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/30/2020

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