Active NPI
Shadye Z Peyvan, LAC
- Acupuncturist
- San Marino, CA
National Provider Identifier
1780915066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 13359
- Practice address
- 2304 Huntington Dr
Suite # 252
San Marino, CA 91108-2649 - Phone
- (626) 292-1274
- Fax
- (626) 292-1274
- NPI assigned
- Jan 26, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 13359 | CA | Primary |
Addresses
Primary practice location
2304 Huntington Dr
Suite # 252
San Marino, CA 91108-2649
Mailing address
2304 Huntington Dr
252
San Marino, CA 91108-2649
Phone (626) 292-1274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13359 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1780915066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2304 HUNTINGTON DR",
"address_2": "252",
"city": "SAN MARINO",
"state": "CA",
"postal_code": "911082649",
"telephone_number": "626-292-1274",
"fax_number": "626-292-1274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2304 HUNTINGTON DR",
"address_2": "SUITE # 252",
"city": "SAN MARINO",
"state": "CA",
"postal_code": "911082649",
"telephone_number": "626-292-1274",
"fax_number": "626-292-1274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEYVAN",
"first_name": "SHADYE",
"middle_name": "Z",
"name_prefix": "Mrs.",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-26",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "13359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Marino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.