Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 56705 | WI |
NPI | 1003076621 |
---|---|
Provider Name | Dr. Shahram Shawn Farahvash |
First Address | Van Nuys, CA 91405-4542 |
Second Address | Van Nuys, CA 91405-4542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 01/12/2021 |