Provider Demographics
NPI:1518656438
Name:SHAHMDSURGEON A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHAHMDSURGEON A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-682-9181
Mailing Address - Street 1:308 WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-3236
Mailing Address - Country:US
Mailing Address - Phone:562-682-9181
Mailing Address - Fax:424-344-2419
Practice Address - Street 1:3628 E IMPERIAL HWY STE 103
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2600
Practice Address - Country:US
Practice Address - Phone:562-682-9181
Practice Address - Fax:310-900-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty