Provider Demographics
NPI:1285932749
Name:SHERVIN ESHAGHIAN MD INC
Entity type:Organization
Organization Name:SHERVIN ESHAGHIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHAGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-6500
Mailing Address - Street 1:PO BOX 10658
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3658
Mailing Address - Country:US
Mailing Address - Phone:310-858-6500
Mailing Address - Fax:310-606-2648
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1405
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-858-6500
Practice Address - Fax:310-606-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97729207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3060930OtherSECRETARY OF STATE CORPORATION NUMBER
CAC3060930OtherSECRETARY OF STATE CORPORATION NUMBER
CAEXO58ZMedicare PIN