Shiva Shabnam MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A110335 Issued in CA

Legal business name

SHIVA SHABNAM MD

Practice address

3275 Tweedy Blvd
South Gate, CA 90280-4348

Phone

(818) 674-0450

Fax

(714) 731-8310

NPI assigned

Mar 15, 2011

Last updated

Mar 15, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shiva Shabnam, MD

Title

President

Phone

(818) 674-0450

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300147200000",
    "number": "1316246416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27851",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928090128",
            "telephone_number": "818-674-0450",
            "fax_number": "714-731-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3275 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902804348",
            "telephone_number": "818-674-0450",
            "fax_number": "714-731-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIVA SHABNAM MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A",
        "authorized_official_last_name": "SHABNAM",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-674-0450",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A110335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in South Gate, CA
• Providers in South Gate, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.