MEDICARE: SHAHRZAD GHODSIAN PA-C

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	363A00000X	Physician Assistant	19856	CA

General Provider Information

NPI Number	:	1215818125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHRZAD GHODSIAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 128
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-0128
Country	:	US
Telephone Number	:	310-560-4326
Fax Number	:

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

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	04/06/2026

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