Provider Demographics
NPI:1033144522
Name:GOLSHANI, ROYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:GOLSHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703611OtherBLUE SHIELD-CA
CA00A703611OtherBLUE SHIELD-CA
CAH43618Medicare UPIN