Provider Demographics
NPI:1013039577
Name:SAFVATI, SHAHRIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRIAR
Middle Name:
Last Name:SAFVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S ROBERTSON BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1632
Mailing Address - Country:US
Mailing Address - Phone:310-659-0666
Mailing Address - Fax:310-659-8754
Practice Address - Street 1:822 S ROBERTSON BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-659-0666
Practice Address - Fax:310-659-8754
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA88634AMedicare PIN
CAI28852Medicare UPIN