Provider Demographics
NPI:1972887271
Name:NADAV, BRIAN SHACHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SHACHAR
Last Name:NADAV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHACHAR
Other - Middle Name:BRIAN
Other - Last Name:NADAV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4501 VISTA DEL MONTE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-6421
Mailing Address - Country:US
Mailing Address - Phone:714-476-3801
Mailing Address - Fax:
Practice Address - Street 1:4501 VISTA DEL MONTE AVE APT 1
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-6421
Practice Address - Country:US
Practice Address - Phone:714-476-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1205642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology