1346477916 NPI number — DR. SAMIR HEMENDRA SHAH M.D.

Table of content: DR. SAMIR HEMENDRA SHAH M.D. (NPI 1346477916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346477916 NPI number — DR. SAMIR HEMENDRA SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
SAMIR
Provider Middle Name:
HEMENDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346477916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92863-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-571-5000
Provider Business Mailing Address Fax Number:
714-571-5055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 S BATAVIA ST
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-571-5000
Provider Business Practice Location Address Fax Number:
714-571-5055
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  456943 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: A146967 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341466 . This is a "LNI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 341461 . This is a "LNI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MD60456943 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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