Provider Demographics
NPI:1174546493
Name:YADEGAR, SHAHRYAR (MD)
Entity type:Individual
Prefix:
First Name:SHAHRYAR
Middle Name:
Last Name:YADEGAR
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 1133
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-0133
Mailing Address - Country:US
Mailing Address - Phone:310-914-9105
Mailing Address - Fax:310-914-9105
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-609-7536
Practice Address - Fax:818-344-9670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61475207RC0200X, 207RP1001X, 207RS0012X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A614758Medicaid
CA00A614758Medicaid