Healthcare Provider Details

I. General information

NPI: 1457308223
Provider Name (Legal Business Name): JOHN SHAIB, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 TELEGRAPH RD STE 100 ATTENTION: MAGGIE NOLES MS 6160
DOWNEY CA
90240-2395
US

IV. Provider business mailing address

PO BOX 486 ATTENTION: MAGGIE NOLES MS 6160
ARTESIA CA
90702-0486
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-0954
  • Fax: 562-231-1904
Mailing address:
  • Phone: 562-741-4461
  • Fax: 562-741-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN K SHAIB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-741-4461