Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G86962 | CA |
NPI | 1003885922 |
---|---|
Provider Name | Javaid Ahmed Shad |
First Address | Oceanside, CA 92056-4499 |
Second Address | Oceanside, CA 92056-4499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G869620 | (05) | CA |
H77504 | (02) |