Provider Demographics
NPI:1548418627
Name:VYAS, SHAIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIL
Middle Name:M
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8245 E MONTE VISTA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1295
Mailing Address - Country:US
Mailing Address - Phone:310-433-8928
Mailing Address - Fax:
Practice Address - Street 1:8245 E MONTE VISTA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1295
Practice Address - Country:US
Practice Address - Phone:310-433-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96346207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery