Healthcare Provider Details

I. General information

NPI: 1306006374
Provider Name (Legal Business Name): KEVIN ALFRED SHAPIRO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E GREEN ST STE 205
PASADENA CA
91101-5405
US

IV. Provider business mailing address

731 E WALNUT ST
PASADENA CA
91101-1613
US

V. Phone/Fax

Practice location:
  • Phone: 213-373-4003
  • Fax:
Mailing address:
  • Phone: 415-952-6050
  • Fax: 415-789-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA125891
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA125891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: