Provider Demographics
NPI:1700855210
Name:SHAHMIR, EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:SHAHMIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BURTON DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3557
Mailing Address - Country:US
Mailing Address - Phone:707-446-4379
Mailing Address - Fax:707-446-4417
Practice Address - Street 1:1360 BURTON DR
Practice Address - Street 2:SUITE 160
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3557
Practice Address - Country:US
Practice Address - Phone:707-446-4379
Practice Address - Fax:707-446-4417
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50331207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82648Medicare UPIN
CAEW947ZMedicare PIN