Healthcare Provider Details

I. General information

NPI: 1780615724
Provider Name (Legal Business Name): PAYAM SHADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 W PICO BLVD
LOS ANGELES CA
90035-3301
US

IV. Provider business mailing address

PO BOX 49879
LOS ANGELES CA
90049-0879
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-9999
  • Fax:
Mailing address:
  • Phone: 323-938-9999
  • Fax: 323-456-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA78965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: