Provider Demographics
NPI:1316177280
Name:POUYA SHAFIPOUR MD INC
Entity type:Organization
Organization Name:POUYA SHAFIPOUR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-996-9355
Mailing Address - Street 1:1950 SAWTELLE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7072
Mailing Address - Country:US
Mailing Address - Phone:310-996-9355
Mailing Address - Fax:310-494-0061
Practice Address - Street 1:1950 SAWTELLE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7072
Practice Address - Country:US
Practice Address - Phone:310-996-9355
Practice Address - Fax:310-494-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care