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General NPI Number Information
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NPI Number | 1164607677
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Entity Type | Individual
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Provider Name | SHAMIM VAHID SHAKIBAI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 8733 BEVERLY BLVD STE 306
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1843
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Country | US
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Telephone | 310-388-6798
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Fax | 323-400-4302
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Provider Business Mailing Address
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Address Line | PO BOX 491352
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City | LOS ANGELES
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State | CA
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Zip | 90049-9352
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Country | US
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Telephone | 310-923-2370
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Fax | 424-208-2835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A100843
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License Number State | CA
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