NPIMap

Organization Active NPI

Dr Mona Shah Professional Corporation

  • Internal Medicine Physician
  • San Pedro, CA
National Provider Identifier
1053643171
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A56119 Issued in CA
Legal business name
DR MONA SHAH PROFESSIONAL CORPORATION
Practice address
1600 S Gaffey St
San Pedro, CA 90731-4628
Phone
(310) 548-0201
Fax
(310) 547-3340
NPI assigned
Feb 1, 2010
Last updated
Sep 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mona Shah, M.D.NPI 1609087543
Title
Owner
Phone
(310) 548-0201

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A56119 CA Primary

Addresses

Primary practice location

1600 S Gaffey St
San Pedro, CA 90731-4628

Mailing address

1600 S Gaffey St
San Pedro, CA 90731-4628
Phone (310) 548-0201

Other practice location 1

1366 W 7th St
San Pedro, CA 90732-3517
Phone (310) 833-2461 ext. 3221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100405000187 CA Part B Supplier - Clinic/Group Practice 2062548084 Receives reassigned benefits from 19 practitioners
Practice locations: San Pedro, CA

National Provider Directory

National Provider Directory

Locations

1294 W 6th St
Ste 205
San Pedro, CA 90731
Phone (310) 548-0201

1360 W 6th St
Ste 120
San Pedro, CA 90732
Phone (310) 548-0201

1600 S Gaffey St
San Pedro, CA 90731
Phone (310) 548-0201

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600992000000",
    "number": "1053643171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S GAFFEY ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907314628",
            "telephone_number": "310-548-0201",
            "fax_number": "310-547-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S GAFFEY ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907314628",
            "telephone_number": "310-548-0201",
            "fax_number": "310-547-3340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1366 W 7th St",
            "address_purpose": "LOCATION",
            "city": "San Pedro",
            "state": "CA",
            "postal_code": "907323517",
            "country_code": "US",
            "telephone_number": "310-833-2461 x3221",
            "fax_number": "310-833-6342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR MONA SHAH PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-01",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "MONA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-548-0201",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A56119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.