Provider Demographics
NPI:1104991686
Name:ADHAMI, AFSHIN SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:SHAWN
Last Name:ADHAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10400 LA GRANGE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5168
Mailing Address - Country:US
Mailing Address - Phone:818-329-1777
Mailing Address - Fax:626-350-9580
Practice Address - Street 1:3030 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3352
Practice Address - Country:US
Practice Address - Phone:626-350-9540
Practice Address - Fax:626-350-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G819192Medicaid
CA00G819191Medicaid
CAGR0099860Medicaid
CA00G819191Medicaid
CAW18175Medicare ID - Type UnspecifiedMEDICARE