Provider Demographics
NPI:1568602852
Name:SHAGINYAN, SERGEI (LAC)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:
Last Name:SHAGINYAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LINCOLN BLVD
Mailing Address - Street 2:STE#2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-451-5276
Mailing Address - Fax:310-451-5276
Practice Address - Street 1:824 LINCOLN BLVD
Practice Address - Street 2:STE#2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-451-5276
Practice Address - Fax:310-451-5276
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist