Provider Demographics
NPI:1295819969
Name:SHAMASH, KAMAL EZOURY (MD)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:EZOURY
Last Name:SHAMASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-991-1842
Mailing Address - Fax:650-991-3367
Practice Address - Street 1:901 CAMPUS DRIVE
Practice Address - Street 2:112
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-991-1842
Practice Address - Fax:650-991-3367
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA301830Medicaid
00A301830Medicare ID - Type Unspecified
CAA301830Medicaid