Provider Demographics
NPI:1265659312
Name:SHAH, MAHMUNIR (MD)
Entity type:Individual
Prefix:
First Name:MAHMUNIR
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAYYAR
Other - Middle Name:MUNIR
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5338 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3090
Mailing Address - Country:US
Mailing Address - Phone:714-994-2273
Mailing Address - Fax:714-994-2224
Practice Address - Street 1:7851 WALKER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1747
Practice Address - Country:US
Practice Address - Phone:714-994-2273
Practice Address - Fax:714-994-2224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C424930Medicaid
CAC42493Medicare PIN
CAE68866Medicare UPIN