Healthcare Provider Details

I. General information

NPI: 1487611026
Provider Name (Legal Business Name): SHAHIN LAGHAEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S OAK AVE BUILDING A SUITE 3
OAKDALE CA
95361-3572
US

IV. Provider business mailing address

PO BOX 3749
MODESTO CA
95352-3749
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-575-4598
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA82720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: