Provider Demographics
NPI:1265526701
Name:CHRISSIAN, SHAVARSH A (MD)
Entity type:Individual
Prefix:DR
First Name:SHAVARSH
Middle Name:A
Last Name:CHRISSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 PONCE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3335
Mailing Address - Country:US
Mailing Address - Phone:818-887-0264
Mailing Address - Fax:
Practice Address - Street 1:WEST LOS ANGELES VA MEDICAL CENTER
Practice Address - Street 2:11301 WILSHIRE BLVD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4935
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37950208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation