=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336448695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARONA YASHAR, MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2011
-----------------------------------------------------
Last Update Date | 10/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9808 VENICE BLVD STE 600
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90232-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-513-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9808 VENICE BLVD STE 600
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90232-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-513-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHARONA YASHAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-632-6388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A95389
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------