Basic Information
Provider Information
NPI: 1962847541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AL-SHATHRI
FirstName: ZIYAD
MiddleName: ABDULAZIZ
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber: 3103018707
FaxNumber: 3103018751
Practice Location
Address1: 200 MED PLAZA SUITE 365, 450, 120
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 90095
CountryCode: US
TelephoneNumber: 3104490939
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2013
LastUpdateDate: 08/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X  N Other Service ProvidersSpecialist 
207RP1001XA154880CAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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