MEDICARE: DR. KAVIAN SHAHI M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	G86147	CA

General Provider Information

NPI Number	:	1174509418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVIAN SHAHI M.D., PH.D.

Provider Business Mailing Address
First Line	:	1301 SECRET RAVINE PKWY
Second Line	:	SUITE 200
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-771-3300
Fax Number	:	916-771-3443

Provider Business Practice Location Address
First Line	:	1301 SECRET RAVINE PKWY
Second Line	:	SUITE 200
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-771-3300
Fax Number	:	916-771-3443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	03/07/2023

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