MEDICARE: DR. BABAK SHAYESTEHFAR 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	2085R0202X	Diagnostic Radiology Physician	A60260	CA

General Provider Information

NPI Number	:	1801831466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABAK SHAYESTEHFAR M.D.

Provider Business Mailing Address
First Line	:	10767 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2324
Country	:	US
Telephone Number	:	818-301-6700
Fax Number	:	818-301-6701

Provider Business Practice Location Address
First Line	:	10767 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2324
Country	:	US
Telephone Number	:	818-301-6700
Fax Number	:	818-301-6701

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/13/2015

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