Healthcare Provider Details

I. General information

NPI: 1235343161
Provider Name (Legal Business Name): SHAHID H SIAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD 616
LOS ANGELES CA
90017-4810
US

IV. Provider business mailing address

FILE 57550
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-1225
  • Fax: 213-977-1239
Mailing address:
  • Phone: 213-977-1225
  • Fax: 213-977-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA49659
License Number StateCA

VIII. Authorized Official

Name: SHAHID H SIAL
Title or Position: OWNER
Credential: MD
Phone: 213-977-1225