Healthcare Provider Details

I. General information

NPI: 1649308446
Provider Name (Legal Business Name): SHANT VARTANIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # S-321
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

513 PARNASSUS AVE # S-321
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-1239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA91607
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA91607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: