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General NPI Number Information
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NPI Number | 1104997311
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Entity Type | Organization
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Legal Business Name | SHADI MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 8815 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3301
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Country | US
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Telephone | 323-938-9999
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Fax | 323-456-0880
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Provider Business Mailing Address
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Address Line | PO BOX 49879
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City | LOS ANGELES
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State | CA
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Zip | 90049-0879
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Country | US
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Telephone | 323-938-9999
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Fax | 323-456-0880
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAYAM SHADI
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Credential | M.D.
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Telephone | 323-938-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | A78965
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License Number State | CA
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