Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A93749 | CA |
NPI | 1033145800 |
---|---|
Provider Name | Ronak Chandrakant Shah |
First Address | Modesto, CA 95355-4201 |
Second Address | Modesto, CA 95355-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 23/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A937490 | (05) | CA |
H93996 | (02) |