Provider Demographics
NPI:1346364403
Name:SHAH, KAUSHIK HARSHAD
Entity Type:Individual
Prefix:DR
First Name:KAUSHIK
Middle Name:HARSHAD
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 AUDLEY ST APT 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1955
Mailing Address - Country:US
Mailing Address - Phone:713-734-0199
Mailing Address - Fax:
Practice Address - Street 1:8610 MLK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-2308
Practice Address - Country:US
Practice Address - Phone:713-734-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30181122300000X, 1223G0001X
IL190272011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist