Provider Demographics
NPI:1346415395
Name:SARAFZADEH, SHADEN (MD)
Entity type:Individual
Prefix:
First Name:SHADEN
Middle Name:
Last Name:SARAFZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:955
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-650-2000
Mailing Address - Fax:818-650-3000
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:955
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4339
Practice Address - Country:US
Practice Address - Phone:818-650-2000
Practice Address - Fax:818-650-3000
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA120299207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology