Provider Demographics
NPI:1174631402
Name:SHAH, NAYAN M (MD)
Entity Type:Individual
Prefix:MS
First Name:NAYAN
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 S DIAMONDBAR BLVD
Mailing Address - Street 2:#186
Mailing Address - City:DIAMONDBAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-268-3899
Mailing Address - Fax:909-598-8307
Practice Address - Street 1:1142 S DIAMOND BAR BLVD
Practice Address - Street 2:#186
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-268-3899
Practice Address - Fax:909-598-8307
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A402530Medicaid
CA00A402530Medicaid