MEDICARE: ACADEMIC MEDICAL RESEARCH INSTITUTE INC

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	207RN0300X	Nephrology Physician	A042315	CA

General Provider Information

NPI Number	:	1639231327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMIC MEDICAL RESEARCH INSTITUTE INC

Provider Business Mailing Address
First Line	:	PO BOX 1019
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91031-1019
Country	:	US
Telephone Number	:	323-842-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4302
Country	:	US
Telephone Number	:	323-725-0051
Fax Number	:	323-869-9245

Authorized Official
Title or Position	:	MEDICAL DIRECTOR & CEO
Name	:	PROF. MOHAMED ALI EL-SHAHAWY
Credential	:	MD,MPH,MHA
Telephone Number	:	323-725-0051

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	11/14/2024

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