1467756684 NPI number — DR. ANKITA GANDHI SHAH M.D.

Table of content: DR. ANKITA GANDHI SHAH M.D. (NPI 1467756684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467756684 NPI number — DR. ANKITA GANDHI SHAH M.D.

Organization/Personal Information

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

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:
1467756684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 OCONNOR DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-1633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-283-7676
Provider Business Mailing Address Fax Number:
408-283-7646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 OCONNOR DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-283-7676
Provider Business Practice Location Address Fax Number:
408-283-7646
Provider Enumeration Date:
01/03/2011

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: 207Q00000X , with the licence number:  A111973 , 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)