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General NPI Number Information
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NPI Number | 1518846385
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Entity Type | Organization
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Legal Business Name | SHIFA REGENERATIVE CENTER AND PAIN MANAGEMENT
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 17150 EUCLID ST STE 207
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4092
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Country | US
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Telephone | 714-875-3755
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Fax | 714-875-3755
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Provider Business Mailing Address
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Address Line | 2012 FALLEN LEAF PL
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City | TUSTIN
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State | CA
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Zip | 92780-6713
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Country | US
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Telephone | 714-875-3755
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. AMJAD AL-KHAWALDEH
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Credential | PHD, NP
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Telephone | 714-875-3755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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