Provider Demographics
NPI:1518116466
Name:HOOMAN SHABATIAN MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HOOMAN SHABATIAN MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-927-2704
Mailing Address - Street 1:17609 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3866
Mailing Address - Country:US
Mailing Address - Phone:818-774-2755
Mailing Address - Fax:
Practice Address - Street 1:17609 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3866
Practice Address - Country:US
Practice Address - Phone:818-774-2755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty