Basic Information
| Provider Information | |||||||||
| NPI: | 1508171570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOROUTAN | ||||||||
| FirstName: | SHAHIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1020 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952013120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094686000 | ||||||||
| FaxNumber: | 2094687042 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 NE 87TH AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986641965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605141854 | ||||||||
| FaxNumber: | 3605146063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2010 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD208986 | OR | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | MD208986 | WA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | MD208986 | OR | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | MD208986 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A118403 | CA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.