NPIMap

Individual provider Active NPI

Shafagh Monazzam, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • South Gate, CA
National Provider Identifier
1619276573
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
A120465 Issued in CA
Practice address
4067 Tweedy Blvd
South Gate, CA 90280-6146
Phone
(323) 569-1126
Fax
(877) 403-7113
NPI assigned
Mar 17, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0114X A120465 CA Primary

Addresses

Primary practice location

4067 Tweedy Blvd
South Gate, CA 90280-6146

Mailing address

16215 Wayfarer LN
Huntington Beach, CA 92649-2149
Phone (714) 595-2250

Other practice location 1

1040 Elm Ave Ste 100
Long Beach, CA 90813-3265
Phone (323) 569-1126

Other identifiers 1

IdentifierTypeStateIssuer
130223MedicaidCA

Other names 1

  • Dr. Shan Monazzam Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131021000556 CA Practitioner - Orthopedic Surgery 0547495970 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of California, San Diego School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4067 Tweedy Blvd
South Gate, CA 90280-6146
Phone (323) 569-1126

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A120465CAMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trong B Nguyen MD Inc Single Specialty CurrentSince May 1, 2024 Accepting new patients
Saint Francis Medical Center Past Accepting new patients
St Francis Medical Center Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
University of California Irvine Past Accepting new patients
Coast Plaza Doctors Hospital Past Accepting new patients
St. Mary Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
St Mary Medical Center Inc Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients

Locations

18035 Brookhurst St
Ste 1100
Fountain Vly, CA 92708
Phone (714) 432-8880

1040 Elm Ave
Ste 100
Long Beach, CA 90813
Phone (562) 491-2145

4067 Tweedy Blvd
South Gate, CA 90280
Phone (323) 563-1160

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: smonazzam538555@direct.memorialcare.org
  • Direct secure messaging: smonazzam@smm-ca.direct.office.nextgen.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1619276573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16215 WAYFARER LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926492149",
            "telephone_number": "714-595-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4067 TWEEDY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806146",
            "telephone_number": "323-569-1126",
            "fax_number": "877-403-7113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1040 Elm Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908133265",
            "country_code": "US",
            "telephone_number": "323-569-1126",
            "fax_number": "877-403-7113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONAZZAM",
        "first_name": "SHAFAGH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-17",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "CA",
            "license": "A120465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130223",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAN",
            "last_name": "MONAZZAM",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.