MEDICARE: DR. SHAFAGH MONAZZAM MD

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	A120465	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619276573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAFAGH MONAZZAM MD

Provider Business Mailing Address
First Line	:	16215 WAYFARER LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2149
Country	:	US
Telephone Number	:	714-595-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	4067 TWEEDY BLVD
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-6146
Country	:	US
Telephone Number	:	323-569-1126
Fax Number	:	877-403-7113

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

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	01/29/2021

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