Provider Demographics
NPI:1134534308
Name:VARGHESE, SHINY M (MD)
Entity type:Individual
Prefix:DR
First Name:SHINY
Middle Name:M
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037
Mailing Address - Country:US
Mailing Address - Phone:323-541-1411
Mailing Address - Fax:323-541-1499
Practice Address - Street 1:808 W 58TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3632
Practice Address - Country:US
Practice Address - Phone:323-541-1411
Practice Address - Fax:323-541-1499
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104544207R00000X
CAA145929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine