Provider Demographics
NPI:1457582934
Name:GANJIAN, SHAHROUZ DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHROUZ
Middle Name:DANIEL
Last Name:GANJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:GANJIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5627
Mailing Address - Country:US
Mailing Address - Phone:310-829-4403
Mailing Address - Fax:
Practice Address - Street 1:1821 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5627
Practice Address - Country:US
Practice Address - Phone:310-829-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1139782080B0002X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine