Provider Demographics
NPI:1326681966
Name:TSIPPORA SHAINHOUSE MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TSIPPORA SHAINHOUSE MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TSIPPORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAINHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-302-0394
Mailing Address - Street 1:414 S LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4816
Mailing Address - Country:US
Mailing Address - Phone:718-510-2419
Mailing Address - Fax:424-239-7050
Practice Address - Street 1:239 S LA CIENEGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3319
Practice Address - Country:US
Practice Address - Phone:424-302-0394
Practice Address - Fax:424-239-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty