Healthcare Provider Details

I. General information

NPI: 1568729580
Provider Name (Legal Business Name): SHYAM RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2012
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE 2ND FLOOR SOUTH
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

1 LEAGUE PO BOX 60844
IRVINE CA
92602
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA129042
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA129042
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA129042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: