Provider Demographics
NPI:1649777814
Name:SHAH, JAIMINI SAMIR (ARDMS)
Entity Type:Individual
Prefix:
First Name:JAIMINI
Middle Name:SAMIR
Last Name:SHAH
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:DR
Other - First Name:JAIMINI
Other - Middle Name:JAYANTILAL
Other - Last Name:BHAVSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:780 BERRYESSA ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-8891
Mailing Address - Country:US
Mailing Address - Phone:510-676-9423
Mailing Address - Fax:
Practice Address - Street 1:780 BERRYESSA ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-8891
Practice Address - Country:US
Practice Address - Phone:510-676-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1799632471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography