Healthcare Provider Details

I. General information

NPI: 1275095895
Provider Name (Legal Business Name): MIR SHANAZ HOSSAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANAZ HOSSAIN

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N SAN VICENTE BLVD STE 209
WEST HOLLYWOOD CA
90048-1810
US

IV. Provider business mailing address

310 N SAN VICENTE BLVD STE 209
WEST HOLLYWOOD CA
90048-1810
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9331
  • Fax:
Mailing address:
  • Phone: 310-423-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA208551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: