MEDICARE: DR. SHAHRAM SHAFI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	A170899	CA

General Provider Information

NPI Number	:	1952840746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRAM SHAFI M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD STE 10A
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2764
Country	:	US
Telephone Number	:	805-565-0020
Fax Number	:

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

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	04/15/2021

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