Healthcare Provider Details

I. General information

NPI: 1639345960
Provider Name (Legal Business Name): SHAHIN LAGHAEE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 FAIRVIEW LN
SONORA CA
95370-4856
US

IV. Provider business mailing address

PO BOX 3749
MODESTO CA
95352-3749
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-575-4598
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA82720
License Number StateCA

VIII. Authorized Official

Name: MICHELLE WATTLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-575-4575