Provider Demographics
NPI:1386088920
Name:SHOAI, MICHAEL SIAMAK (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SIAMAK
Last Name:SHOAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:SIAMAK
Other - Last Name:SHOAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16604 PARK LANE PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1150
Mailing Address - Country:US
Mailing Address - Phone:310-471-0842
Mailing Address - Fax:310-471-0842
Practice Address - Street 1:16604 PARK LANE PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1150
Practice Address - Country:US
Practice Address - Phone:310-471-0842
Practice Address - Fax:310-471-0842
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE37766207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease