Provider Demographics
NPI:1477659266
Name:NAIEM, SHAHRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:NAIEM
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 1:8871 BURTON WAY
Mailing Address - Street 2:104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3716
Mailing Address - Country:US
Mailing Address - Phone:310-991-0375
Mailing Address - Fax:310-388-1251
Practice Address - Street 1:8871 BURTON WAY
Practice Address - Street 2:104
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-3748
Practice Address - Country:US
Practice Address - Phone:310-991-0375
Practice Address - Fax:310-388-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952976030OtherGROUP TAX ID
CAWA69178AOtherMEDICARE ID
CA00A691780Medicaid
CAH85697Medicare UPIN
CA00A691780Medicaid
CAHW1249AMedicare PIN
CAHW1249Medicare PIN