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General NPI Number Information
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NPI Number | 1689619454
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Entity Type | Organization
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Legal Business Name | SHAUN S DANESHRAD MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 8920 WILSHIRE BLVD SUITE 420
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2007
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Country | US
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Telephone | 310-652-5210
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Fax | 310-652-5211
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Provider Business Mailing Address
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Address Line | PO BOX 2054
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City | BEVERLY HILLS
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State | CA
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Zip | 90213-2054
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Country | US
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Telephone | 310-652-5210
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAUN S DANESHRAD
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Credential | M.D.
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Telephone | 310-652-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G70241
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License Number State | CA
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