Provider Demographics
NPI:1609946169
Name:ASHOURI, SHAHRYAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:A
Last Name:ASHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAY
Other - Middle Name:A
Other - Last Name:ASHOURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 LA VENTA DR STE 202
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3769
Practice Address - Country:US
Practice Address - Phone:805-496-5153
Practice Address - Fax:805-496-5202
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87932207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A879320Medicaid
CABA550Medicare PIN