Healthcare Provider Details

I. General information

NPI: 1881068807
Provider Name (Legal Business Name): GASTROENTEROLOGY HOSPITALIST ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1837
US

IV. Provider business mailing address

PO BOX 67189
LOS ANGELES CA
90067-0189
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-2224
  • Fax:
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA91773
License Number StateCA

VIII. Authorized Official

Name: OMID SHAYE
Title or Position: PRESIDENT
Credential: MD
Phone: 310-858-2224