Provider Demographics
NPI:1861611931
Name:SHAYE, OMID S (MD)
Entity type:Individual
Prefix:DR
First Name:OMID
Middle Name:S
Last Name:SHAYE
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 1:7320 WOODLAKE AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1474
Mailing Address - Country:US
Mailing Address - Phone:818-346-1773
Mailing Address - Fax:818-346-3010
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1474
Practice Address - Country:US
Practice Address - Phone:818-346-1773
Practice Address - Fax:818-346-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81628207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA0837Medicare PIN