Provider Demographics
NPI:1568500684
Name:SHAHIN LAGHAEE MD INC
Entity Type:Organization
Organization Name:SHAHIN LAGHAEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGHAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-575-4575
Mailing Address - Street 1:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-3749
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:250 S OAK AVE
Practice Address - Street 2:BUILDING A SUITE 3
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3572
Practice Address - Country:US
Practice Address - Phone:209-848-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A827200Medicaid
CAZZZ27131ZMedicare PIN
CAH43510Medicare UPIN