Provider Demographics
NPI:1821085689
Name:SAAD, SHAWKI DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SHAWKI
Middle Name:DAVID
Last Name:SAAD
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 1:18250 ROSCOE BLVD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4226
Mailing Address - Country:US
Mailing Address - Phone:818-998-8591
Mailing Address - Fax:818-998-1196
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-998-8591
Practice Address - Fax:818-998-1196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42321174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A423211Medicaid
CA00A423211Medicaid
CAWA42321KMedicare ID - Type Unspecified