Healthcare Provider Details

I. General information

NPI: 1518023126
Provider Name (Legal Business Name): SHAHIN GHADIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 320
BEVERLY HILLS CA
90211-1969
US

IV. Provider business mailing address

135 S ROSEMEAD BLVD
PASADENA CA
91107-3955
US

V. Phone/Fax

Practice location:
  • Phone: 310-943-5820
  • Fax:
Mailing address:
  • Phone: 626-204-9699
  • Fax: 626-440-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA74590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: