Provider Demographics
NPI:1679149876
Name:ULLAH, SHAKIR
Entity type:Individual
Prefix:
First Name:SHAKIR
Middle Name:
Last Name:ULLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:UNKNOWN
Other - Middle Name:
Other - Last Name:SHAKIR ULLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3429 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5844
Mailing Address - Country:US
Mailing Address - Phone:818-423-3320
Mailing Address - Fax:
Practice Address - Street 1:25820 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-4381
Practice Address - Country:US
Practice Address - Phone:310-325-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA193970208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program