Provider Demographics
NPI:1518023126
Name:GHADIR, SHAHIN (MD)
Entity Type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:GHADIR
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 1:450 N ROXBURY DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4226
Mailing Address - Country:US
Mailing Address - Phone:310-277-2393
Mailing Address - Fax:310-274-5112
Practice Address - Street 1:450 N ROXBURY DR STE 500
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4226
Practice Address - Country:US
Practice Address - Phone:310-277-2393
Practice Address - Fax:310-274-5112
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist