Provider Demographics
NPI:1114926433
Name:SHAOULIAN, NATAN RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATAN
Middle Name:RYAN
Last Name:SHAOULIAN
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 1:503 N REXFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3309
Mailing Address - Country:US
Mailing Address - Phone:310-278-2525
Mailing Address - Fax:310-278-4355
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-278-2525
Practice Address - Fax:310-278-2525
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-09-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-09-28
Provider Licenses
StateLicense IDTaxonomies
CAA724402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A724400Medicaid
CAH60772Medicare UPIN
CAA72440Medicare ID - Type Unspecified