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General NPI Number Information
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NPI Number | 1679779649
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Entity Type | Individual
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Provider Name | SHAHIN E SHEIBANI-RAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE 1150
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-477-0787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261274
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City | ENCINO
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State | CA
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Zip | 91426-1274
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Country | US
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Telephone | 818-481-9230
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Fax |
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | A130858
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License Number State | CA
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