Provider Demographics
NPI:1083288625
Name:SENAATI, SHAYAN (DO)
Entity type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:SENAATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 CORTE PORTOFINO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3245
Mailing Address - Country:US
Mailing Address - Phone:310-606-0077
Mailing Address - Fax:
Practice Address - Street 1:1170 BAKER ST STE H1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4165
Practice Address - Country:US
Practice Address - Phone:949-791-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A21028207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine