Provider Demographics
NPI:1629413000
Name:JAYKUMAR H. SHAH, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAYKUMAR H. SHAH, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYKUMAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-446-4404
Mailing Address - Street 1:623 W DUARTE RD
Mailing Address - Street 2:#7
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7330
Mailing Address - Country:US
Mailing Address - Phone:626-446-4404
Mailing Address - Fax:626-446-0599
Practice Address - Street 1:623 W DUARTE RD
Practice Address - Street 2:#7
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7330
Practice Address - Country:US
Practice Address - Phone:626-446-4404
Practice Address - Fax:626-446-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42091261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care