Provider Demographics
NPI:1962160564
Name:SHAHRAM S FARAHVASH MD INC
Entity type:Organization
Organization Name:SHAHRAM S FARAHVASH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:FARAHVASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-349-4943
Mailing Address - Street 1:15732 SUTTON ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3407
Mailing Address - Country:US
Mailing Address - Phone:173-494-9439
Mailing Address - Fax:
Practice Address - Street 1:15732 SUTTON ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3407
Practice Address - Country:US
Practice Address - Phone:917-349-4943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital