Provider Demographics
NPI:1164607677
Name:SHAKIBAI, SHAMIM VAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:VAHID
Last Name:SHAKIBAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 491352
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-9352
Mailing Address - Country:US
Mailing Address - Phone:310-923-2370
Mailing Address - Fax:424-208-2835
Practice Address - Street 1:8733 BEVERLY BLVD STE 306
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1843
Practice Address - Country:US
Practice Address - Phone:310-388-6798
Practice Address - Fax:323-400-4302
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA100843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213807Medicare PIN