Provider Demographics
NPI:1639275050
Name:SHAH, KIRAN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 HUNTERVALE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3804
Mailing Address - Country:US
Mailing Address - Phone:951-737-6004
Mailing Address - Fax:951-737-6004
Practice Address - Street 1:14031 HUNTERVALE DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-3804
Practice Address - Country:US
Practice Address - Phone:951-737-6004
Practice Address - Fax:951-737-6004
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice