Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A16182 | CA |
NPI | 1023464336 |
---|---|
Provider Name | Jay Shah |
First Address | Fremont, CA 94538-1626 |
Second Address | Fremont, CA 94538-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 24/08/2020 |