Provider Demographics
NPI:1841290400
Name:SHOHAM, STEVEN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHARLES
Last Name:SHOHAM
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 1:10515 BALBOA BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6343
Mailing Address - Country:US
Mailing Address - Phone:818-832-3322
Mailing Address - Fax:818-360-9171
Practice Address - Street 1:10515 BALBOA BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6343
Practice Address - Country:US
Practice Address - Phone:818-832-3322
Practice Address - Fax:818-360-9171
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50826208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G508260Medicaid
CA00G508260Medicaid
G50826Medicare ID - Type Unspecified