Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 61434 | CA |
Y | 1223P0221X | Pediatric Dentist | 61434 | CA |
NPI | 1003159864 |
---|---|
Provider Name | Priyal Shah Ohri |
First Address | Anaheim, CA 92807 |
Second Address | Garden Grove, CA 92840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2013 |
Last Update Date | 25/10/2018 |