Provider Demographics
NPI:1629306881
Name:JIVABHAI PATEL, SHAMIN (MD)
Entity Type:Individual
Prefix:
First Name:SHAMIN
Middle Name:
Last Name:JIVABHAI PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAMIN
Other - Middle Name:AMRATLAL
Other - Last Name:JIVABHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:BLDG 56, STE 600, ZOT 4490
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-6920
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 56, STE 600, ZOT 4490
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics