Provider Demographics
NPI:1629295845
Name:NASSERI, SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:NASSERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:S
Other - Last Name:NASSERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 788
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-729-3116
Mailing Address - Fax:310-289-8205
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-289-8200
Practice Address - Fax:310-289-8205
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71218207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology