Provider Demographics
NPI:1316163660
Name:SHAYAN, PAYAM (DC)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:SHAYAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 SHERMAN WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4051
Mailing Address - Country:US
Mailing Address - Phone:818-609-7844
Mailing Address - Fax:818-609-1949
Practice Address - Street 1:18701 SHERMAN WAY STE 4
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4051
Practice Address - Country:US
Practice Address - Phone:818-609-7844
Practice Address - Fax:818-609-1949
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU74789Medicare UPIN
DC26141AMedicare ID - Type Unspecified