Healthcare Provider Details

I. General information

NPI: 1750314415
Provider Name (Legal Business Name): SHADIAR OHADI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 RIVERSIDE DR STE 220
SHERMAN OAKS CA
91423-2512
US

IV. Provider business mailing address

13320 RIVERSIDE DR STE 220
SHERMAN OAKS CA
91423-2512
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-4400
  • Fax: 818-848-4406
Mailing address:
  • Phone: 818-848-4400
  • Fax: 818-848-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: