Provider Demographics
NPI:1790041770
Name:SHAHRAM F. RAVAN,M.D., INC.
Entity Type:Organization
Organization Name:SHAHRAM F. RAVAN,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:FRANCIOS
Authorized Official - Last Name:RAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-9200
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-858-9200
Mailing Address - Fax:310-271-3793
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:SUITE 214
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4310
Practice Address - Country:US
Practice Address - Phone:310-858-9200
Practice Address - Fax:310-271-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40168207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401680Medicaid
CA00A401680Medicaid