Provider Demographics
NPI:1750314415
Name:OHADI, SHADIAR (DO)
Entity Type:Individual
Prefix:
First Name:SHADIAR
Middle Name:
Last Name:OHADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:STE 311
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:818-848-4400
Mailing Address - Fax:818-979-9111
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE 311
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-848-4400
Practice Address - Fax:818-979-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO7628817OtherDEA
CA00AX80360Medicare UPIN