Provider Demographics
NPI:1962487421
Name:JAVAHERI, SHAHIN M (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHIN
Middle Name:M
Last Name:JAVAHERI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:NUMBER 626
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-204-8800
Mailing Address - Fax:415-921-1015
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:NUMBER 626
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-204-8800
Practice Address - Fax:415-921-1015
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-07-12
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Provider Licenses
StateLicense IDTaxonomies
CAG67343208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60700Medicare UPIN
CA00G673431Medicare UPIN