MEDICARE: DR. POUYA SHAFIPOUR MD

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	207Q00000X	Family Medicine Physician	A89513	CA

General Provider Information

NPI Number	:	1952426454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POUYA SHAFIPOUR MD

Provider Business Mailing Address
First Line	:	1831 WILSHIRE BLVD STE B
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5778
Country	:	US
Telephone Number	:	310-400-5565
Fax Number	:	310-400-5566

Provider Business Practice Location Address
First Line	:	1831 WILSHIRE BLVD STE B
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5778
Country	:	US
Telephone Number	:	310-400-5565
Fax Number	:	310-400-5566

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/19/2021

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