Provider Demographics
NPI:1720201379
Name:SHABATIAN, HOOMAN (MD)
Entity Type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:SHABATIAN
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 1:17609 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3866
Mailing Address - Country:US
Mailing Address - Phone:818-774-2755
Mailing Address - Fax:
Practice Address - Street 1:17609 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3866
Practice Address - Country:US
Practice Address - Phone:818-774-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87662208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty