Healthcare Provider Details

I. General information

NPI: 1164082855
Provider Name (Legal Business Name): SANAM TIFFANY SHAHROOZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 911
LOS ANGELES CA
90067-2012
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 911
LOS ANGELES CA
90067-2012
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-1220
  • Fax: 310-229-1222
Mailing address:
  • Phone: 310-229-1220
  • Fax: 310-229-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA185754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: