Healthcare Provider Details

I. General information

NPI: 1255486866
Provider Name (Legal Business Name): SHAHRAM F. RAVAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD. SUITE 200
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

9001 WILSHIRE BLVD. SUITE 200
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-9200
  • Fax: 310-271-3793
Mailing address:
  • Phone: 310-858-9200
  • Fax: 310-271-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberA40168
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHRAM F RAVAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-857-0800