Provider Demographics
NPI:1093035479
Name:AVA SHAMBAN A MEDICAL CORPORATION
Entity type:Organization
Organization Name:AVA SHAMBAN A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SHAMBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-2282
Mailing Address - Street 1:9915 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1606
Mailing Address - Country:US
Mailing Address - Phone:310-843-9915
Mailing Address - Fax:310-843-9925
Practice Address - Street 1:9915 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1606
Practice Address - Country:US
Practice Address - Phone:310-843-9915
Practice Address - Fax:310-843-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty