Provider Demographics
NPI:1083704076
Name:SAFVATI, SHAVASH (MD)
Entity Type:Individual
Prefix:
First Name:SHAVASH
Middle Name:
Last Name:SAFVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR
Mailing Address - Street 2:SUITE #303
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-760-2434
Mailing Address - Fax:818-760-8832
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:SUITE #303
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-760-2434
Practice Address - Fax:818-760-8832
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49842208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A498420Medicaid
F30603Medicare UPIN
CAA49842Medicare ID - Type Unspecified