Provider Demographics
NPI:1245431980
Name:VIVIAN N. SHIRVANI, M.D. INC
Entity Type:Organization
Organization Name:VIVIAN N. SHIRVANI, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:NEGAR
Authorized Official - Last Name:SHIRVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-592-2377
Mailing Address - Street 1:PO BOX 16411
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2411
Mailing Address - Country:US
Mailing Address - Phone:310-592-2377
Mailing Address - Fax:310-423-4599
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-657-9277
Practice Address - Fax:310-423-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20895Medicare PIN