Provider Demographics
NPI:1073831160
Name:QAVI, SHAHBAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHBAZ
Middle Name:
Last Name:QAVI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4471 PACIFIC COAST HWY APT A304
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5694
Mailing Address - Country:US
Mailing Address - Phone:419-509-8001
Mailing Address - Fax:949-853-8581
Practice Address - Street 1:17822 BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7172
Practice Address - Country:US
Practice Address - Phone:714-375-1122
Practice Address - Fax:949-863-8581
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2022-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA163249207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100233173Medicaid