Provider Demographics
NPI:1790795953
Name:SHAH, BEENA H (MD)
Entity Type:Individual
Prefix:
First Name:BEENA
Middle Name:H
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19713, YORBA LINDA BLVD
Mailing Address - Street 2:#54
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7109
Mailing Address - Country:US
Mailing Address - Phone:714-547-7008
Mailing Address - Fax:
Practice Address - Street 1:20505 YORBA LINDA BLVD
Practice Address - Street 2:STE 541
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7109
Practice Address - Country:US
Practice Address - Phone:714-547-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42702207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93845Medicare UPIN