Provider Demographics
NPI:1306942545
Name:SHOGA, WAIL AKRAM (DO)
Entity type:Individual
Prefix:DR
First Name:WAIL
Middle Name:AKRAM
Last Name:SHOGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4670
Mailing Address - Country:US
Mailing Address - Phone:626-963-3682
Mailing Address - Fax:626-914-5419
Practice Address - Street 1:2025 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4670
Practice Address - Country:US
Practice Address - Phone:626-852-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine