Provider Demographics
NPI:1851465504
Name:SHAH, UMESH (MD)
Entity Type:Individual
Prefix:
First Name:UMESH
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 1:12540 10TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3503
Mailing Address - Country:US
Mailing Address - Phone:909-591-6414
Mailing Address - Fax:
Practice Address - Street 1:12540 10TH ST
Practice Address - Street 2:STE B
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3503
Practice Address - Country:US
Practice Address - Phone:909-591-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34147207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A341470Medicare PIN