Basic Information
Provider Information
NPI: 1548268287
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOLHPOUR
FirstName: SHAHRAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2141 N HARBOR BLVD STE 35000
Address2:  
City: FULLERTON
State: CA
PostalCode: 928353831
CountryCode: US
TelephoneNumber: 7146268630
FaxNumber:  
Practice Location
Address1: 2141 N HARBOR BLVD
Address2: SUITE 35000
City: FULLERTON
State: CA
PostalCode: 928353827
CountryCode: US
TelephoneNumber: 7146268630
FaxNumber: 7146268659
Other Information
ProviderEnumerationDate: 07/07/2005
LastUpdateDate: 11/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XA87058CAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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