Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A52601 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A52601 | CA |
NPI | 1700834140 |
---|---|
Provider Name | Virag Y Shah |
First Address | Cerritos, CA 90703-9329 |
Second Address | Cerritos, CA 90703-9329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 16/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G89276 | (02) | CA |