Provider Demographics
NPI:1902110257
Name:SHOHET EAR ASSOCIATES MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SHOHET EAR ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOHET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-631-4327
Mailing Address - Street 1:PO BOX 2472
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-1472
Mailing Address - Country:US
Mailing Address - Phone:949-574-4600
Mailing Address - Fax:949-574-4680
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:949-631-4327
Practice Address - Fax:949-631-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15557Medicare PIN