Provider Demographics
NPI:1508867136
Name:SHAH, ARCHANA P (MD)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:P
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 1:1002 N. FAIRVIEW
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703
Mailing Address - Country:US
Mailing Address - Phone:714-835-8501
Mailing Address - Fax:714-835-3912
Practice Address - Street 1:1002 N. FAIRVIEW
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-835-8501
Practice Address - Fax:714-835-3912
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549150OtherMEDI CAL
CAG59109Medicare UPIN