Provider Demographics
NPI:1770083081
Name:SHAHRYAR DAVARI MD PC
Entity type:Organization
Organization Name:SHAHRYAR DAVARI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-922-2020
Mailing Address - Street 1:17595 HARVARD AVE # C1005
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11544 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4955
Practice Address - Country:US
Practice Address - Phone:562-922-2020
Practice Address - Fax:562-286-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76725OtherMEDICAL BOARD OF CALIFORNIA