Healthcare Provider Details

I. General information

NPI: 1174693501
Provider Name (Legal Business Name): SHAHE N JIERIAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 E WASHINGTON BLVD SUITE 102
PASADENA CA
91104-2757
US

IV. Provider business mailing address

1668 E WASHINGTON BLVD SUITE 102
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 818-469-4101
  • Fax:
Mailing address:
  • Phone: 818-469-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: