MEDICARE: SHANHAT YACOB

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	208100000X	Physical Medicine & Rehabilitation Physician	307932	CA

General Provider Information

NPI Number	:	1477404317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANHAT YACOB

Provider Business Mailing Address
First Line	:	4820 LINCOLN BLVD
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6917
Country	:	US
Telephone Number	:	310-392-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 LINCOLN BLVD
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6917
Country	:	US
Telephone Number	:	310-392-7889
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ SHANHAT YACOB ” Practice Location

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