Provider Demographics
NPI:1851339048
Name:SHAIB, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:SHAIB
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:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0486
Mailing Address - Country:US
Mailing Address - Phone:562-861-0954
Mailing Address - Fax:562-861-3739
Practice Address - Street 1:9040 TELEGRAPH RD
Practice Address - Street 2:SITE 100
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-2393
Practice Address - Country:US
Practice Address - Phone:562-861-0954
Practice Address - Fax:562-861-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110060907OtherRAILROAD
P00357366OtherRAILROAD
015521OtherHEALTH NET ID #
CA00G402050Medicaid
CA00G402051OtherBLUE SHIELD #
CA00G402050OtherBLUE SHIELD #
A48136Medicare UPIN
CA00G402050Medicaid