Provider Demographics
NPI:1043395973
Name:RAHIM SHAPOORY M.D. INC.
Entity Type:Organization
Organization Name:RAHIM SHAPOORY M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:SHAPOORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-845-6800
Mailing Address - Street 1:421 E ANGELENO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2286
Mailing Address - Country:US
Mailing Address - Phone:818-845-6800
Mailing Address - Fax:818-843-7871
Practice Address - Street 1:421 E ANGELENO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2286
Practice Address - Country:US
Practice Address - Phone:818-845-6800
Practice Address - Fax:818-843-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28518207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CA=========OtherTAX ID