Individual provider Active NPI

Shayan Rad, PSY.D.

  • Clinical Psychologist
  • Glendale, CA
National Provider Identifier
1770946402
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
33289 Issued in CA
Practice address
1560 E Chevy Chase Dr Ste 130
Glendale, CA 91206-4140
Phone
(818) 240-0340
NPI assigned
Mar 31, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 33289 CA
Clinical Psychologist 103TC0700X 33289 CA Primary

Addresses

Primary practice location

1560 E Chevy Chase Dr Ste 130
Glendale, CA 91206-4140

Mailing address

1560 E Chevy Chase Dr Ste 130
Glendale, CA 91206-4140
Phone (818) 240-0340

Other practice location 1

1314 W Glenoaks Blvd
Ste 205
Glendale, CA 91201-1978
Phone (818) 658-5502

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250228002442 CA Practitioner - Clinical Psychologist 2567982952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

1560 E Chevy Chase Dr
Suite 130
Glendale, CA 91206-4140
Phone (925) 282-1778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33289CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Coast Psychiatric Associates Inc Clinical CurrentSince Jan 26, 2025 Accepting new patients
Ac and CS Past Accepting new patients
Vital Medical Group, Inc PastSince Apr 9, 2024 Accepting new patients

Locations

1560 E Chevy Chase Dr
Ste 130
Glendale, CA 91206
Phone (818) 240-0340

6200 Wilshire Blvd
Ste 1410
Los Angeles, CA 90048
Phone (323) 403-0474

490 Post St
Ste 1043
San Francisco, CA 94102
Phone (415) 409-0944

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1770946402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E CHEVY CHASE DR STE 130",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064140",
            "telephone_number": "818-240-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 E CHEVY CHASE DR STE 130",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064140",
            "telephone_number": "818-240-0340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1314 W Glenoaks Blvd",
            "address_2": "STE 205",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912011978",
            "country_code": "US",
            "telephone_number": "818-658-5502",
            "fax_number": "818-751-5171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAD",
        "first_name": "SHAYAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-31",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "33289",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "33289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.