Provider Demographics
NPI:1972008423
Name:SHAHIN JAVAHERI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHAHIN JAVAHERI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT / BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:WEIXLER
Authorized Official - Middle Name:
Authorized Official - Last Name:VILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-696-5400
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1029
Mailing Address - Country:US
Mailing Address - Phone:415-923-3800
Mailing Address - Fax:415-923-5900
Practice Address - Street 1:2100 WEBSTER ST STE 502
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2381
Practice Address - Country:US
Practice Address - Phone:415-923-3800
Practice Address - Fax:415-923-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67343208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty