Healthcare Provider Details

I. General information

NPI: 1437188604
Provider Name (Legal Business Name): MICHAEL SHAHANGIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

17151 NEWHOPE ST SUITE 201
FOUNTAIN VALLEY CA
92708-4226
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-0642
  • Fax:
Mailing address:
  • Phone: 714-754-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA31455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: