Provider Demographics
NPI:1104282888
Name:GEORGE K SHAHINIAN MD INC
Entity type:Organization
Organization Name:GEORGE K SHAHINIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-521-6060
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 620
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3672
Mailing Address - Country:US
Mailing Address - Phone:949-521-6060
Mailing Address - Fax:949-521-6063
Practice Address - Street 1:24411 HEALTH CENTER DR STE 620
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3672
Practice Address - Country:US
Practice Address - Phone:949-521-6060
Practice Address - Fax:949-521-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty