Provider Demographics
NPI:1760695696
Name:ESHAGHIAN, SHERVIN (MD)
Entity Type:Individual
Prefix:
First Name:SHERVIN
Middle Name:
Last Name:ESHAGHIAN
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:PO BOX 10658
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3658
Mailing Address - Country:US
Mailing Address - Phone:310-858-6500
Mailing Address - Fax:310-606-2648
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1405
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-858-6500
Practice Address - Fax:310-606-2648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97729207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3060930OtherSECRETARY OF STATE DEPT OF COROPORATIONS
CAC3060930OtherSECRETARY OF STATE DEPT OF COROPORATIONS