| Shine Mmg | |
|
450 N Brand Blvd Ste 625a Glendale CA 91203-2347 | |
| (818) 745-0070 | |
| (818) 745-0065 |
| Full Name | Shine Mmg |
|---|---|
| Speciality | Family Medicine |
| Location | 450 N Brand Blvd Ste 625a, Glendale, California |
| Authorized Official Name and Position | Emil Golub (CFO) |
| Authorized Official Contact | 4242046004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Mmg 450 N Brand Blvd Ste 625a Glendale CA 91203-2347 Ph: (818) 745-0070 | Shine Mmg 450 N Brand Blvd Ste 625a Glendale CA 91203-2347 Ph: (818) 745-0070 |
| NPI Number | 1053930248 |
|---|---|
| Provider Enumeration Date | 04/08/2020 |
| Last Update Date | 04/08/2020 |
| Medicare PECOS PAC ID | 6103257282 |
|---|---|
| Medicare Enrollment ID | O20200505000514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053930248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Policarpio F Enriquez |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1205945029 PECOS PAC ID: 2264491885 Enrollment ID: I20041007000674 |
| Provider Name | Soumitra Sarkar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578573010 PECOS PAC ID: 6103978432 Enrollment ID: I20090717000457 |
| Provider Name | Gihan S Abdel-samed |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306884754 PECOS PAC ID: 0042239626 Enrollment ID: I20151204000520 |
| Provider Name | Analiza Farahbakhsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780229674 PECOS PAC ID: 5799113775 Enrollment ID: I20200325002950 |
| Provider Name | Da Som Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407484058 PECOS PAC ID: 5294153730 Enrollment ID: I20210121002728 |
| Provider Name | Amanda Spino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750939526 PECOS PAC ID: 0547679714 Enrollment ID: I20210429002840 |
| Provider Name | Ben John Shannon-alferes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487146593 PECOS PAC ID: 3274930714 Enrollment ID: I20210924002583 |
| Provider Name | Claudia C Talbot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376206797 PECOS PAC ID: 6002206521 Enrollment ID: I20211123003195 |
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