Basic Information
| Provider Information | |||||||||
| NPI: | 1013991116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANAHAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | S.M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 511228 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900512997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5623098200 | ||||||||
| Practice Location | |||||||||
| Address1: | 12401 EAST WASHINGTON BLVD. | ||||||||
| Address2: | PRESBYTERIAN INTERCOMMUNITY HOSP-RADIOLOGY DEPARTMENT | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906021006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
| FaxNumber: | 5623098200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G41618 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00GH16180 | 01 | CA | MEDI CAL | OTHER | 1205815107 | 05 | CA | MEDICAID | 00G756000 | 01 | CA | BS OF CALIFORNIA | OTHER |