1952510851 NPI number — USMAN S SHAH MD

Table of content: USMAN S SHAH MD (NPI 1952510851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952510851 NPI number — USMAN S SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
USMAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952510851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOAG DRIVE
Provider Second Line Business Mailing Address:
3 NORTH INTENSIVIST OFFICE
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
442-600-5128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOAG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-4162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-764-6876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007

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: 207R00000X , with the licence number:  57011000 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: A106624 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD-14844 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: A106624 , 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: 0000278572 . This is a "HMSA BILLING NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 622979-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".