Healthcare Provider Details

I. General information

NPI: 1972007235
Provider Name (Legal Business Name): SEAN NEWSHA ERSHADI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE STE 101
ARCADIA CA
91006-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5139
  • Fax:
Mailing address:
  • Phone: 626-821-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number1972007235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: