Provider Demographics
NPI:1952510596
Name:PEDRAM SHIRZAD D O A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:PEDRAM SHIRZAD D O A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-988-5999
Mailing Address - Street 1:14624 SHERMAN WAY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2241
Mailing Address - Country:US
Mailing Address - Phone:818-988-5999
Mailing Address - Fax:818-988-5005
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4006
Practice Address - Country:US
Practice Address - Phone:818-676-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty