Provider Demographics
NPI:1477811891
Name:YAGHOUBIAN, SHADI (MD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:YAGHOUBIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W 3RD ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6105
Mailing Address - Country:US
Mailing Address - Phone:310-402-0548
Mailing Address - Fax:310-421-2381
Practice Address - Street 1:8635 W 3RD ST STE 1050
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6105
Practice Address - Country:US
Practice Address - Phone:310-402-0548
Practice Address - Fax:310-421-2381
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131868208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist