Healthcare Provider Details

I. General information

NPI: 1396071908
Provider Name (Legal Business Name): SHIVA ESHAGHIAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N. BEDORD DR. STE 209
BEVERLY HILLS CA
90210-4306
US

IV. Provider business mailing address

16661 VENTURA BLVD STE 824
ENCINO CA
91436-4802
US

V. Phone/Fax

Practice location:
  • Phone: 516-404-5109
  • Fax: 323-370-6817
Mailing address:
  • Phone: 818-784-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number20575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: