Provider Demographics
NPI:1801830963
Name:CHOWDHURY, SHAWN (PA)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 S WESTERN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5808
Mailing Address - Country:US
Mailing Address - Phone:323-730-0310
Mailing Address - Fax:323-730-1335
Practice Address - Street 1:1828 S WESTERN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5808
Practice Address - Country:US
Practice Address - Phone:323-730-0310
Practice Address - Fax:323-730-1335
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12761363AM0700X
CA12761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12761OtherMEDICAL LICENSE NUMBER