Healthcare Provider Details

I. General information

NPI: 1578896247
Provider Name (Legal Business Name): TSIPPORA SHAINHOUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S LA CIENEGA BLVD STE 200
BEVERLY HILLS CA
90211-3319
US

IV. Provider business mailing address

414 S LAS PALMAS AVE
LOS ANGELES CA
90020-4816
US

V. Phone/Fax

Practice location:
  • Phone: 424-302-0394
  • Fax: 424-239-7050
Mailing address:
  • Phone: 718-510-2419
  • Fax: 424-239-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82036
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA82036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: