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General NPI Number Information
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NPI Number | 1760589097
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Entity Type | Organization
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Legal Business Name | SHAHRAM JAVAHERI, MD, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 26691 PLAZA STE 150
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6329
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Country | US
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Telephone | 949-389-0660
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Fax | 949-389-0668
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Provider Business Mailing Address
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Address Line | PO BOX 12512
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-5065
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Country | US
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Telephone | 949-389-0660
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Fax | 949-389-0668
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAHRAM JAVAHERI
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Credential | M.D.
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Telephone | 949-389-0660
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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 | A064239
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License Number State | CA
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