Individual
DR. SHAFAGH MONAZZAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4067 TWEEDY BLVD, SOUTH GATE, CA 90280-6146
(323) 569-1126
(877) 403-7113
Mailing address
16215 WAYFARER LN, HUNTINGTON BEACH, CA 92649-2149
(714) 595-2250
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
A120465
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130223
—
CA
Enumeration date
03/17/2011
Last updated
01/29/2021
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