| Shiraz Medical Group, Inc | |
|
16952 Ventura Blvd Ste 100 Encino CA 91316-4124 | |
| (818) 789-3964 | |
| (818) 789-3967 |
| Full Name | Shiraz Medical Group, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16952 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Keyvan Shirazi (CEO) |
| Authorized Official Contact | 8187893964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiraz Medical Group, Inc 16952 Ventura Blvd Ste 100 Encino CA 91316-4124 Ph: (818) 789-3964 | Shiraz Medical Group, Inc 16952 Ventura Blvd Ste 100 Encino CA 91316-4124 Ph: (818) 789-3964 |
| NPI Number | 1558367649 |
|---|---|
| Provider Enumeration Date | 06/22/2005 |
| Last Update Date | 09/11/2014 |
| Medicare PECOS PAC ID | 3274561600 |
|---|---|
| Medicare Enrollment ID | O20050727001099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558367649 | NPI | - | NPPES |
| 00A781840 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A78184 (California) | Primary |
| Provider Name | Keyvan Shirazi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023033107 PECOS PAC ID: 8426064296 Enrollment ID: I20060302000691 |
| Provider Name | Caroline Go |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881308823 PECOS PAC ID: 5799159786 Enrollment ID: I20230314001540 |
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