Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 31035 | AZ |
NPI | 1114940335 |
---|---|
Provider Name | Dr. Nish S Shah |
First Address | Chandler, AZ 85224 |
Second Address | Chandler, AZ 85224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
786600 | (05) | AZ |
I12350 | (02) |