Provider Demographics
NPI:1164584413
Name:SHAHINIAN, LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:SHAHINIAN
Suffix:JR
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 1:1174 CASTRO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2568
Mailing Address - Country:US
Mailing Address - Phone:650-961-2585
Mailing Address - Fax:650-961-6527
Practice Address - Street 1:1174 CASTRO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2568
Practice Address - Country:US
Practice Address - Phone:650-961-2585
Practice Address - Fax:650-961-6527
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22885207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G228850Medicaid
180045935OtherRAILROAD MEDICARE
180045935OtherRAILROAD MEDICARE
CA00G228850Medicaid