Healthcare Provider Details

I. General information

NPI: 1811258726
Provider Name (Legal Business Name): BRIAN SOHEIL SHAFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-1928
US

IV. Provider business mailing address

8907 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90211-1928
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-5443
  • Fax:
Mailing address:
  • Phone: 310-666-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA168640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: