Provider Demographics
NPI:1639894637
Name:USMAN S. SHAH, MD
Entity Type:Organization
Organization Name:USMAN S. SHAH, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-600-5128
Mailing Address - Street 1:PO BOX 5434
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5434
Mailing Address - Country:US
Mailing Address - Phone:442-600-5128
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR.
Practice Address - Street 2:BLDG 39, 1ST FLOOR
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-9266
Practice Address - Country:US
Practice Address - Phone:949-764-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty