Healthcare Provider Details

I. General information

NPI: 1265902928
Provider Name (Legal Business Name): SHIVANGI AMIN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N ALVARADO ST FL 1
LOS ANGELES CA
90026
US

IV. Provider business mailing address

701 N ALVARADO ST FL 1
LOS ANGELES CA
90026-4005
US

V. Phone/Fax

Practice location:
  • Phone: 213-908-5008
  • Fax: 213-908-5079
Mailing address:
  • Phone: 213-908-5008
  • Fax: 213-908-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHIVANGI AMIN
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 213-908-5008