Healthcare Provider Details

I. General information

NPI: 1487111480
Provider Name (Legal Business Name): SHAHIN ABRISHAMCHIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 CHANTILLY RD
BEL AIR CA
90077-1300
US

IV. Provider business mailing address

1171 CHANTILLY RD
BEL AIR CA
90077-1300
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-9806
  • Fax: 310-405-7360
Mailing address:
  • Phone: 818-456-9806
  • Fax: 310-405-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: