Provider Demographics
NPI:1780680546
Name:SHAH, YATIN (MD)
Entity Type:Individual
Prefix:DR
First Name:YATIN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:925-875-6100
Mailing Address - Fax:
Practice Address - Street 1:4050 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3112
Practice Address - Country:US
Practice Address - Phone:925-875-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53259208000000X
TXK1668208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Y185OtherBCBS PROVIDER NUMBER
TX125438503Medicaid
TX1655359001OtherCIGNA PROV NUMBER
TX123734100OtherFIRST CARE PROV NUMBER
TX141962301OtherUNITED HEALTHCARE PROV NO
TX5004343OtherAETNA PROVIDER NUMBER
TXG30087Medicare UPIN
TX123734100OtherFIRST CARE PROV NUMBER