Provider Demographics
NPI:1790715241
Name:MEHDIZADEH, SHAHAB (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:
Last Name:MEHDIZADEH
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 1:240 S LA CIENEGA BLVD
Mailing Address - Street 2:SUIT 102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3324
Mailing Address - Country:US
Mailing Address - Phone:310-246-4100
Mailing Address - Fax:310-285-2029
Practice Address - Street 1:240 S LA CIENEGA BLVD
Practice Address - Street 2:SUIT 102
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3324
Practice Address - Country:US
Practice Address - Phone:310-246-4100
Practice Address - Fax:310-285-2029
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76490207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology