Provider Demographics
NPI:1801778402
Name:SHAFIEE SHAMS, ALI MOHAMMAD
Entity type:Individual
Prefix:
First Name:ALI MOHAMMAD
Middle Name:
Last Name:SHAFIEE SHAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13353 CARDINAL RIDGE RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1279
Mailing Address - Country:US
Mailing Address - Phone:949-992-4141
Mailing Address - Fax:
Practice Address - Street 1:13353 CARDINAL RIDGE RD UNIT A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1279
Practice Address - Country:US
Practice Address - Phone:949-992-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program