Active NPI
Mark Scott Shamoon, PSY.D.
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1194315184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 32352
- Practice address
- 1626 Westwood Blvd Ste 102
Los Angeles, CA 90024-5621 - Phone
- (424) 262-9836
- NPI assigned
- Jan 22, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 32352 | CA | Primary |
Addresses
Primary practice location
1626 Westwood Blvd Ste 102
Los Angeles, CA 90024-5621
Mailing address
1626 Westwood Blvd Ste 102
Los Angeles, CA 90024-5621
Phone (424) 262-9836
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32352 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659052800000",
"number": "1194315184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1626 WESTWOOD BLVD STE 102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900245621",
"telephone_number": "424-262-9836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1626 WESTWOOD BLVD STE 102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900245621",
"telephone_number": "424-262-9836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMOON",
"first_name": "MARK",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-22",
"last_updated": "2022-07-29",
"certification_date": "2022-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "32352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.