MEDICARE: MR. SHAHID HUSSAIN SIAL M.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	207RG0100X	Gastroenterology Physician	A49659	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	562426145	OTHER	CA	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00A496590	OTHER	CA	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1750381844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAHID HUSSAIN SIAL M.D.

Provider Business Mailing Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	STE 616
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	310-400-4189
Fax Number	:	310-347-4246

Provider Business Practice Location Address
First Line	:	1245 WILSHIRE BLVD
Second Line	:	STE 616
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4806
Country	:	US
Telephone Number	:	310-400-4189
Fax Number	:	310-347-4246

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/02/2017

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Directions to “ MR. SHAHID HUSSAIN SIAL M.D.” Practice Location

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