Provider Demographics
NPI:1598882078
Name:TOURAJ SHAFAI, M.D. INC
Entity Type:Organization
Organization Name:TOURAJ SHAFAI, M.D. INC
Other - Org Name:INLAND EMPIRE CHILDREN'S MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOURAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:951-682-9780
Mailing Address - Street 1:7101 MAGNOLIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:951-682-9780
Mailing Address - Fax:951-682-9787
Practice Address - Street 1:7101 MAGNOLIA AVE
Practice Address - Street 2:STE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:951-682-9780
Practice Address - Fax:951-682-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA250312080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty