Provider Demographics
NPI:1578612339
Name:SHAHIN, BISHARA JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BISHARA
Middle Name:JOHN
Last Name:SHAHIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 VIA VERDE
Mailing Address - Street 2:PMB 121
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-860-2880
Mailing Address - Fax:909-860-2885
Practice Address - Street 1:1127 VIA VERDE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4428
Practice Address - Country:US
Practice Address - Phone:909-860-2880
Practice Address - Fax:909-860-2885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical