Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019031535 | IL |
NPI | 1003354911 |
---|---|
Provider Name | Pinkesh Shah |
First Address | Hoffman Estates, IL 60169-5207 |
Second Address | Chicago, IL 60609-3013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2017 |
Last Update Date | 21/03/2018 |