Provider Demographics
NPI:1356678692
Name:PATEL, SHOUNUCK ISHVER (DO)
Entity Type:Individual
Prefix:DR
First Name:SHOUNUCK
Middle Name:ISHVER
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 STATUARY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3551
Mailing Address - Country:US
Mailing Address - Phone:202-277-3130
Mailing Address - Fax:
Practice Address - Street 1:5020 CAMPUS DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2111
Practice Address - Country:US
Practice Address - Phone:310-929-9790
Practice Address - Fax:310-929-9791
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A137882081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine