Provider Demographics
NPI:1689869190
Name:SHAHRAM F. RAVAN, M.D. INC.
Entity Type:Organization
Organization Name:SHAHRAM F. RAVAN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:FRANCOIS
Authorized Official - Last Name:RAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-9200
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-858-9200
Mailing Address - Fax:310-271-3793
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:SUITE 214
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-858-9200
Practice Address - Fax:310-271-3793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHRAM F. RAVAN, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401680Medicaid
CAA40168Medicare PIN
CA00A401680Medicaid