Provider Demographics
NPI:1992703912
Name:TAMADON, SHOKOUH (MD)
Entity type:Individual
Prefix:
First Name:SHOKOUH
Middle Name:
Last Name:TAMADON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 WHITTIER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2136
Mailing Address - Country:US
Mailing Address - Phone:562-945-6440
Mailing Address - Fax:562-945-9121
Practice Address - Street 1:15111 WHITTIER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2136
Practice Address - Country:US
Practice Address - Phone:562-945-6440
Practice Address - Fax:562-945-9121
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485170OtherBLUE SHIELD
CAB002OtherCHAMPUS
CA080181067OtherMEDICARE RAIL ROAD
CA00A485170Medicaid
CAA48517OtherBCBS
CAA48517OtherBCBS
CA00A485170Medicaid