Provider Demographics
NPI:1073399804
Name:DOA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VAHEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRVANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-624-1290
Mailing Address - Street 1:3893 VILLA VISTA PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2028
Mailing Address - Country:US
Mailing Address - Phone:818-624-1290
Mailing Address - Fax:
Practice Address - Street 1:24335 MAGIC MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-3402
Practice Address - Country:US
Practice Address - Phone:818-624-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty