=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821020272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARMEN A. SHAHBAZIAN, MD, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 04/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2617 E CHAPMAN AVE SUITE 102
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92869-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-639-1955
-----------------------------------------------------
Fax | 714-639-1958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2617 E CHAPMAN AVE SUITE 102
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92869-3226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-639-1955
-----------------------------------------------------
Fax | 714-639-1958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ARMEN A SHAHBAZIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-639-1955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | C37327
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------