Active NPI
Dr Mona Shah Professional Corporation
- Internal Medicine Physician
- San Pedro, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A56119
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mona Shah, M.D.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
1360 W 6th St
San Pedro, CA 90732
Phone (310) 546-3461
1360 W 6th St
Ste 120
San Pedro, CA 90732
Phone (310) 428-4699
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.
-
- Cardiovascular Disease Physician
- San Pedro, CA
- NPI 1609850700
CA, Single Specialty
-
- Internal Medicine Physician
- Huntington Beach, CA
- NPI 1639296957
CA, Internal Medicine
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.