Provider Demographics
NPI:1730539792
Name:ROYA GOLSHANI MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROYA GOLSHANI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLSHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-553-5588
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:1804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-5588
Mailing Address - Fax:310-553-5590
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:1804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-5588
Practice Address - Fax:310-553-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH43618Medicare UPIN