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General NPI Number Information
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NPI Number | 1518656438
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Entity Type | Organization
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Legal Business Name | SHAHMDSURGEON A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 3628 E IMPERIAL HWY STE 103
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City | LYNWOOD
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State | CA
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Zip | 90262-2600
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Country | US
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Telephone | 562-682-9181
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Fax | 310-900-5019
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Provider Business Mailing Address
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Address Line | 308 WINSLOW AVE
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City | LONG BEACH
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State | CA
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Zip | 90814-3236
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Country | US
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Telephone | 562-682-9181
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Fax | 424-344-2419
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Authorized Official
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Title or Position | OWNER
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Name | MONA M SHAH
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Credential | MD
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Telephone | 562-682-9181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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