Provider Demographics
NPI:1962944918
Name:SHARIM, KAMBIZ (HIS)
Entity type:Individual
Prefix:
First Name:KAMBIZ
Middle Name:
Last Name:SHARIM
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:SHARIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS
Mailing Address - Street 1:1065 CHANTILLY RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2617
Mailing Address - Country:US
Mailing Address - Phone:949-887-6498
Mailing Address - Fax:805-278-6051
Practice Address - Street 1:1300 W. GONZALES RD
Practice Address - Street 2:SUITE 108
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3354
Practice Address - Country:US
Practice Address - Phone:805-983-0444
Practice Address - Fax:805-278-6051
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4181237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist