Provider Demographics
NPI:1265477749
Name:DELKHAH, SHAHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:DELKHAH
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 1:824 S WOOSTER ST
Mailing Address - Street 2:#308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18855 VICTORY BLVD
Practice Address - Street 2:ATTN BILLING DEPARTMENT
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6445
Practice Address - Country:US
Practice Address - Phone:818-774-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00421946OtherRAILROAD MEDICARE
CAA94156OtherSTATE LICENSE #
CAWA94156COtherPPIN
CAWA94156COtherPPIN
CAI55526Medicare UPIN