Healthcare Provider Details

I. General information

NPI: 1912448226
Provider Name (Legal Business Name): SHAMILI ALLAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 KATELLA AVE STE 109
LOS ALAMITOS CA
90720-3587
US

IV. Provider business mailing address

35 CREEK RD
IRVINE CA
92604-4724
US

V. Phone/Fax

Practice location:
  • Phone: 877-430-7337
  • Fax: 714-445-0245
Mailing address:
  • Phone: 714-445-0220
  • Fax: 714-445-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA157526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: