MEDICARE: DR. JOHN M. SHAMOUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A052955	CA
2	174400000X	Specialist	A052955	CA

General Provider Information

NPI Number	:	1528180544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M. SHAMOUN M.D.

Provider Business Mailing Address
First Line	:	366 SAN MIGUEL DR STE 310
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7810
Country	:	US
Telephone Number	:	949-759-3077
Fax Number	:	949-759-3087

Provider Business Practice Location Address
First Line	:	366 SAN MIGUEL DR STE 310
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7810
Country	:	US
Telephone Number	:	949-759-3077
Fax Number	:	949-759-3087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/06/2020

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