Provider Demographics
NPI:1912010844
Name:SHAHIN, SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:SHAHIN
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 1:8930 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3606
Mailing Address - Country:US
Mailing Address - Phone:310-641-8111
Mailing Address - Fax:310-667-7274
Practice Address - Street 1:8930 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3606
Practice Address - Country:US
Practice Address - Phone:310-641-8111
Practice Address - Fax:310-667-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53276207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice