Provider Demographics
NPI:1770698854
Name:SHAMMAS, HANNA F (MD)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:F
Last Name:SHAMMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SHAMMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3510 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2010
Mailing Address - Country:US
Mailing Address - Phone:310-638-9391
Mailing Address - Fax:310-603-8749
Practice Address - Street 1:3510 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2010
Practice Address - Country:US
Practice Address - Phone:310-638-9391
Practice Address - Fax:310-603-8749
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308000Medicaid
CAA30800OtherCA LICENSE NUMBER
CAWA30800AMedicare PIN
CAA30800OtherCA LICENSE NUMBER