Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 036117369 | IL |
N | 208200000X | Surgeon | 036117369 | IL |
N | 208600000X | Surgeon | 036117369 | IL |
Y | 208200000X | Surgeon | C134519 | CA |
Y | 208600000X | Surgeon | C134519 | CA |
NPI | 1417105602 |
---|---|
Provider Name | Riaz Ali Shah |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Woodland, CA 95695-5131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 17/01/2017 |