Provider Demographics
NPI:1811166655
Name:MASOUEM, SHAHRYAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHRYAR
Middle Name:
Last Name:MASOUEM
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 1:4790 IRVINE BLVD STE 105-337
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1973
Mailing Address - Country:US
Mailing Address - Phone:714-512-2440
Mailing Address - Fax:949-264-8221
Practice Address - Street 1:4790 IRVINE BLVD STE 105-337
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1973
Practice Address - Country:US
Practice Address - Phone:714-512-2440
Practice Address - Fax:949-264-8221
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811166655Medicaid
CACF170ZMedicare PIN