Provider Demographics
NPI:1932252749
Name:S DANIEL GOLSHANI M D INC
Entity Type:Organization
Organization Name:S DANIEL GOLSHANI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAPOUR
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GOLSHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-3481
Mailing Address - Street 1:9301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5424
Mailing Address - Country:US
Mailing Address - Phone:310-274-3481
Mailing Address - Fax:310-274-3482
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-274-3481
Practice Address - Fax:310-274-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76581Medicare ID - Type Unspecified