Provider Demographics
NPI:1407973472
Name:SANGANI, JIGNA SHAH (MD)
Entity Type:Individual
Prefix:
First Name:JIGNA
Middle Name:SHAH
Last Name:SANGANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JIGNA
Other - Middle Name:SHARAD
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:728 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3027
Mailing Address - Country:US
Mailing Address - Phone:650-486-1364
Mailing Address - Fax:
Practice Address - Street 1:801 BREWSTER AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1557
Practice Address - Country:US
Practice Address - Phone:650-216-7794
Practice Address - Fax:650-216-7796
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814790Medicaid
CAI11086Medicare UPIN