Provider Demographics
NPI:1629123070
Name:BEMANIAN, SHAHROOZ
Entity Type:Individual
Prefix:DR
First Name:SHAHROOZ
Middle Name:
Last Name:BEMANIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53366
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3366
Mailing Address - Country:US
Mailing Address - Phone:949-612-9090
Mailing Address - Fax:949-612-9091
Practice Address - Street 1:113 WATERWORKS WAY STE 155
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-612-9090
Practice Address - Fax:949-912-9091
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85501207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW809BMedicare ID - Type UnspecifiedHUDSON
CAW809AMedicare ID - Type UnspecifiedROYBAL