Provider Demographics
NPI:1902982408
Name:ATTARCHI, SHAHAB (MD)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:ATTARCHI
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:PO BOX 241033
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-9998
Mailing Address - Country:US
Mailing Address - Phone:818-888-7090
Mailing Address - Fax:818-888-8919
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1468
Practice Address - Country:US
Practice Address - Phone:818-888-7090
Practice Address - Fax:818-888-8919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A83690OtherBLUE SHIELD
H96456Medicare UPIN
CAWA83690CMedicare PIN