Healthcare Provider Details

I. General information

NPI: 1457708182
Provider Name (Legal Business Name): ADENA SHAHINIAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 07/21/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE STE 325
PASADENA CA
91105-2675
US

IV. Provider business mailing address

625 S FAIR OAKS AVE STE 325
PASADENA CA
91105-2675
US

V. Phone/Fax

Practice location:
  • Phone: 626-535-9344
  • Fax: 626-535-9687
Mailing address:
  • Phone: 626-535-9344
  • Fax: 626-535-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberSL1196
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A18809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: