Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A82527 | CA |
N | 111NI0900X | Internist | A82527 | CA |
N | 207RA0401X | Internist - Addiction Medicine | A82527 | CA |
N | 207RN0300X | Nephrologist | A82527 | CA |
NPI | 1861404535 |
---|---|
Provider Name | Dr. Shahrouz Y. Ghodsian |
First Address | Los Angeles, CA 90024-0673 |
Second Address | Los Angeles, CA 90024-7042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25772 | (02) | CA |