Provider Demographics
NPI:1356609119
Name:RAB, SHAYAN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:
Last Name:RAB
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 1:222 S HILL ST FL 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3508
Mailing Address - Country:US
Mailing Address - Phone:213-600-4043
Mailing Address - Fax:844-823-2619
Practice Address - Street 1:222 S HILL ST FL 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3508
Practice Address - Country:US
Practice Address - Phone:213-600-4043
Practice Address - Fax:844-823-2619
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1279142084P0800X, 174400000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program