1972793917 NPI number — DR. SAYANA R SHAH M.D.

Table of content: DR. SAYANA R SHAH M.D. (NPI 1972793917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972793917 NPI number — DR. SAYANA R SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
SAYANA
Provider Middle Name:
R
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:
1972793917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1043 ELM AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90813-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-491-9890
Provider Business Mailing Address Fax Number:
562-491-9091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1043 ELM AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-491-9890
Provider Business Practice Location Address Fax Number:
562-491-9091
Provider Enumeration Date:
07/26/2007

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: A119100 , 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: 7696936 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P01090150 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972793917 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01090150 . This is a "RAILROAD MCR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9893903 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A119100Z63 . This is a "CALOPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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