Provider Demographics
NPI:1346234952
Name:CANNOM, DAVID SHEFVELAND (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHEFVELAND
Last Name:CANNOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:STE 703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-977-7422
Mailing Address - Fax:213-250-8945
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:STE 703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4807
Practice Address - Country:US
Practice Address - Phone:213-977-7422
Practice Address - Fax:213-250-8945
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33466207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060019748OtherMEDICARE RAILROAD PIN
CA00C334660Medicaid
CAA35289Medicare UPIN
CA00C334660Medicaid