Organization
KIANOUSH SHAKIB MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIANOUSH SHAKIB MD (PRESIDENT)
(917) 669-7949
Entity
Organization
Contact information
Practice address
11661 SAN VICENTE BLVD STE 101, LOS ANGELES, CA 90049-5150
(310) 312-1231
Mailing address
11661 SAN VICENTE BLVD STE 101, LOS ANGELES, CA 90049-5150
(310) 312-1231
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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