Healthcare Provider Details

I. General information

NPI: 1215915517
Provider Name (Legal Business Name): KIARASH SHAHLAIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF NEUROLOGICAL SURGERY 4860 Y STREET, SUITE #3740
SACRAMENTO CA
95817
US

IV. Provider business mailing address

DEPARTMENT OF NEUROLOGICAL SURGERY 4860 Y STREET, SUITE #3740
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3071
  • Fax: 916-452-2580
Mailing address:
  • Phone: 916-734-3071
  • Fax: 916-452-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA79635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: