Healthcare Provider Details

I. General information

NPI: 1972008423
Provider Name (Legal Business Name): SHAHIN JAVAHERI MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 502
SAN FRANCISCO CA
94115-2381
US

IV. Provider business mailing address

PO BOX 1029
MILL VALLEY CA
94942-1029
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3800
  • Fax: 415-923-5900
Mailing address:
  • Phone: 415-923-3800
  • Fax: 415-923-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG67343
License Number StateCA

VIII. Authorized Official

Name: WEIXLER VILA
Title or Position: IT / BILLING SERVICE
Credential:
Phone: 310-696-5400