Provider Demographics
NPI:1861404535
Name:GHODSIAN, SHAHROUZ Y (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHROUZ
Middle Name:Y
Last Name:GHODSIAN
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 24673
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0673
Mailing Address - Country:US
Mailing Address - Phone:310-552-2273
Mailing Address - Fax:310-999-6520
Practice Address - Street 1:11000 WILSHIRE BLVD 24673
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-7042
Practice Address - Country:US
Practice Address - Phone:310-709-7355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82527207R00000X, 207RA0401X, 207RN0300X, 2084A0401X, 208D00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI25772Medicare UPIN
CAWA82527AMedicare PIN