Healthcare Provider Details

I. General information

NPI: 1174546493
Provider Name (Legal Business Name): SHAHRYAR YADEGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18399 VENTURA BLVD SUITE 245
TARZANA CA
91356-4233
US

IV. Provider business mailing address

PO BOX 1133
STUDIO CITY CA
91614-0133
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-7536
  • Fax: 818-344-9670
Mailing address:
  • Phone: 310-914-9105
  • Fax: 310-914-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA61475
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA61475
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA61475
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: