Healthcare Provider Details

I. General information

NPI: 1841290400
Provider Name (Legal Business Name): STEVEN CHARLES SHOHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 BALBOA BLVD SUITE 360
GRANADA HILLS CA
91344-6343
US

IV. Provider business mailing address

10515 BALBOA BLVD SUITE 360
GRANADA HILLS CA
91344-6343
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-3322
  • Fax: 818-360-9171
Mailing address:
  • Phone: 818-832-3322
  • Fax: 818-360-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG50826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: