Provider Demographics
NPI:1194782847
Name:SHAOULIAN, EMANUEL (MD)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:SHAOULIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2778
Practice Address - Country:US
Practice Address - Phone:949-631-6144
Practice Address - Fax:949-281-5011
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41353207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A413530Medicaid
060050288OtherRAILROAD MEDICARE
CA290-808-5OtherECFMG NUMBER
CA290-808-5OtherECFMG NUMBER
060050288OtherRAILROAD MEDICARE
B15735Medicare UPIN