Provider Demographics
NPI:1750396438
Name:SOPHIE SHIRIN M D INC
Entity type:Organization
Organization Name:SOPHIE SHIRIN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-3880
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2203
Mailing Address - Country:US
Mailing Address - Phone:818-905-3880
Mailing Address - Fax:818-905-7806
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-905-3880
Practice Address - Fax:818-905-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66454207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A664540OtherMEDI-CAL PROVIDER NUMBER
CA00A664540OtherMEDI-CAL PROVIDER NUMBER
CAW21444Medicare PIN