Healthcare Provider Details

I. General information

NPI: 1962814517
Provider Name (Legal Business Name): SHAHRAM ESMAILZADEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 N. PALM DR. #204
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

332 N. PALM DR. #204
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-6705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC14377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: