Provider Demographics
NPI:1649358599
Name:FAZILAT, SHAHIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:FAZILAT
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 1:515 SOUTH DR STE 25
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4209
Mailing Address - Country:US
Mailing Address - Phone:650-964-2200
Mailing Address - Fax:650-964-2205
Practice Address - Street 1:515 SOUTH DR STE 25
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4209
Practice Address - Country:US
Practice Address - Phone:650-964-2200
Practice Address - Fax:650-964-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90907208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92-0589712OtherTAX ID