Healthcare Provider Details

I. General information

NPI: 1104183961
Provider Name (Legal Business Name): FERDINAND JAMIL SHAMIYEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 BROOKSHIRE AVE STE 302
DOWNEY CA
90241-4982
US

IV. Provider business mailing address

13322 MILLER AVE
NORWALK CA
90650-3365
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-2821
  • Fax: 562-904-2826
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number134648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: