Provider Demographics
NPI:1427477892
Name:SHABAN, MOHAMED ADAM (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ADAM
Last Name:SHABAN
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 1:1901 NEWPORT BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2281
Mailing Address - Country:US
Mailing Address - Phone:949-646-6224
Mailing Address - Fax:949-646-6222
Practice Address - Street 1:2701 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2701
Practice Address - Country:US
Practice Address - Phone:714-377-6993
Practice Address - Fax:562-933-8557
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1675442080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program