Provider Demographics
NPI:1730484387
Name:E. SHAHAM MEDICAL CORPORATION
Entity Type:Organization
Organization Name:E. SHAHAM MEDICAL CORPORATION
Other - Org Name:WOMEN'S HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSAGAV
Authorized Official - Middle Name:SAGI
Authorized Official - Last Name:SHAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-660-2100
Mailing Address - Street 1:866 N VERMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-3587
Mailing Address - Country:US
Mailing Address - Phone:323-660-2100
Mailing Address - Fax:323-662-0078
Practice Address - Street 1:866 N VERMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3587
Practice Address - Country:US
Practice Address - Phone:323-660-2100
Practice Address - Fax:323-662-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G508240Medicaid
CAF01547Medicare UPIN
CAG50824Medicare PIN