Provider Demographics
NPI:1366845166
Name:DR SHAHROOZ ESHAGHIAN MD INC
Entity Type:Organization
Organization Name:DR SHAHROOZ ESHAGHIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHAGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:3102-293-5555
Mailing Address - Street 1:PO BOX 3758
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-0758
Mailing Address - Country:US
Mailing Address - Phone:310-229-3555
Mailing Address - Fax:310-229-3554
Practice Address - Street 1:470 N ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2328
Practice Address - Country:US
Practice Address - Phone:310-229-3555
Practice Address - Fax:310-229-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100734207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty