Provider Demographics
NPI:1821174137
Name:SHAWN HAMILTON MD INC
Entity Type:Organization
Organization Name:SHAWN HAMILTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-651-9671
Mailing Address - Street 1:4902 IRVINE CENTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3334
Mailing Address - Country:US
Mailing Address - Phone:949-651-9671
Mailing Address - Fax:949-653-0556
Practice Address - Street 1:4902 IRVINE CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3334
Practice Address - Country:US
Practice Address - Phone:949-651-9671
Practice Address - Fax:949-653-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A606520Medicaid
CA05D0558250OtherCLIA
CA00A606520Medicaid
CAA60652Medicare PIN