Healthcare Provider Details

I. General information

NPI: 1487963690
Provider Name (Legal Business Name): HEDYEH SHAFI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD ROOM 8709
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

13448 JAVA DR
BEVERLY HILLS CA
90210-1124
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA114188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: