MEDICARE: GEORGE K SHAHINIAN M D INCORPORATED

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	103TC0700X	Clinical Psychologist	MFC48217	CA
2	207RC0000X	Cardiovascular Disease Physician	G73846	CA
3	207RP1001X	Pulmonary Disease Physician	A63870	CA

General Provider Information

NPI Number	:	1811954720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE K SHAHINIAN M D INCORPORATED

Provider Business Mailing Address
First Line	:	25467 NELLIE GAIL RD
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-6306
Country	:	US
Telephone Number	:	949-521-6060
Fax Number	:	949-521-6063

Provider Business Practice Location Address
First Line	:	11 MAREBLU STE 200
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3044
Country	:	US
Telephone Number	:	949-521-6060
Fax Number	:	949-521-6063

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. GEORGE KEVORK SHAHINIAN
Credential	:	M.D.
Telephone Number	:	949-521-6060

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/25/2023

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