Provider Demographics
NPI:1033467428
Name:SHAHAB MAHBOUBIAN, DO, INC.
Entity Type:Organization
Organization Name:SHAHAB MAHBOUBIAN, DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHBOUBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-209-6528
Mailing Address - Street 1:10640 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2319
Mailing Address - Country:US
Mailing Address - Phone:818-755-6500
Mailing Address - Fax:818-755-8904
Practice Address - Street 1:10640 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2319
Practice Address - Country:US
Practice Address - Phone:818-755-6500
Practice Address - Fax:818-755-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EK237AMedicare UPIN