Provider Demographics
NPI:1487743597
Name:SHAHANGIAN, SEAN SHAHRIAR (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:SHAHRIAR
Last Name:SHAHANGIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAHRIAR
Other - Middle Name:
Other - Last Name:SHAHANGIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5221 CROWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-952-5147
Practice Address - Street 1:235 N HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3627
Practice Address - Country:US
Practice Address - Phone:213-382-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0047940Medicaid
H52549Medicare UPIN
CAA67216Medicare PIN