Provider Demographics
NPI:1952482333
Name:AZMOON, SHAHDAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAHDAD
Middle Name:
Last Name:AZMOON
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 1:10535 FOOTHILL BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7602
Mailing Address - Country:US
Mailing Address - Phone:909-466-8810
Mailing Address - Fax:909-466-8811
Practice Address - Street 1:10535 FOOTHILL BLVD
Practice Address - Street 2:SUITE #365
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3843
Practice Address - Country:US
Practice Address - Phone:909-466-8810
Practice Address - Fax:909-466-8811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91785207RI0011X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease