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General NPI Number Information
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NPI Number | 1568669596
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Entity Type | Organization
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Legal Business Name | SHAHAB MEHDIZADEH MD INC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 240 S LA CIENEGA BLVD 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3324
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Country | US
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Telephone | 310-246-4100
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Fax | 310-285-2029
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Provider Business Mailing Address
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Address Line | 240 S LA CIENEGA BLVD 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3324
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Country | US
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Telephone | 310-246-4100
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Fax | 310-285-2029
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAHAB MEHDIZADEH
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Credential | MD
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Telephone | 310-246-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A76490
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License Number State | CA
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