Provider Demographics
NPI:1932315827
Name:A SHAWN ADHAMI M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:A SHAWN ADHAMI M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:ADHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-346-0555
Mailing Address - Street 1:10400 LA GRANGE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5168
Mailing Address - Country:US
Mailing Address - Phone:626-350-9540
Mailing Address - Fax:626-350-9580
Practice Address - Street 1:1000 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-346-0555
Practice Address - Fax:323-346-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099860Medicaid
CAW18175Medicare ID - Type UnspecifiedMEDICARE
CAGR0099860Medicaid