Healthcare Provider Details

I. General information

NPI: 1528180544
Provider Name (Legal Business Name): JOHN M. SHAMOUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 SAN MIGUEL DR STE 310
NEWPORT BEACH CA
92660-7810
US

IV. Provider business mailing address

366 SAN MIGUEL DR STE 310
NEWPORT BEACH CA
92660-7810
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-3077
  • Fax: 949-759-3087
Mailing address:
  • Phone: 949-759-3077
  • Fax: 949-759-3087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA052955
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA052955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: