Provider Demographics
NPI:1215213566
Name:SHIRVANIAN, SHANT (MD)
Entity Type:Individual
Prefix:
First Name:SHANT
Middle Name:
Last Name:SHIRVANIAN
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 1:435 ARDEN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4014
Mailing Address - Country:US
Mailing Address - Phone:818-247-6676
Mailing Address - Fax:866-887-3856
Practice Address - Street 1:435 ARDEN AVE STE 310
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4014
Practice Address - Country:US
Practice Address - Phone:818-247-6676
Practice Address - Fax:866-887-3856
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2021-11-23
Deactivation Date:2021-10-29
Deactivation Code:
Reactivation Date:2021-11-22
Provider Licenses
StateLicense IDTaxonomies
CAA127830207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine