Provider Demographics
NPI:1629129341
Name:SHAH, AMISH AJIT (MD)
Entity Type:Individual
Prefix:
First Name:AMISH
Middle Name:AJIT
Last Name:SHAH
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 1:3100 DUBLIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4363
Mailing Address - Country:US
Mailing Address - Phone:925-556-5800
Mailing Address - Fax:
Practice Address - Street 1:3100 DUBLIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4363
Practice Address - Country:US
Practice Address - Phone:925-556-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2494212085R0001X
NMMD2011-04072085R0001X
CAC1491562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99851555Medicaid
NMNMAAA1317Medicare PIN