Provider Demographics
NPI:1114352812
Name:FATEMA A SHAMIM MD INC
Entity Type:Organization
Organization Name:FATEMA A SHAMIM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATEMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAMIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-409-9190
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:STE 221
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-677-9131
Mailing Address - Fax:310-677-0254
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:STE 221
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-677-9131
Practice Address - Fax:310-677-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87291208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty