Healthcare Provider Details

I. General information

NPI: 1982081014
Provider Name (Legal Business Name): SHAWN PAKRAVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

18040 SHERMAN WAY STE 304
RESEDA CA
91335-4656
US

V. Phone/Fax

Practice location:
  • Phone: 310-721-4395
  • Fax:
Mailing address:
  • Phone: 310-721-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA167092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: