Provider Demographics
NPI:1578664934
Name:SHAH, HIREN C (MD)
Entity Type:Individual
Prefix:
First Name:HIREN
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:19713 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE#54
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3532
Mailing Address - Country:US
Mailing Address - Phone:626-810-3330
Mailing Address - Fax:626-964-0440
Practice Address - Street 1:19713 YORBA LINDA BLVD
Practice Address - Street 2:SUITE#54
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3532
Practice Address - Country:US
Practice Address - Phone:626-810-3330
Practice Address - Fax:626-964-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42703207Q00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A427030Medicaid
CAWA42703CMedicare ID - Type Unspecified
CA00A427030Medicaid