Provider Demographics
NPI:1932289162
Name:SHAH, KALYANI KANDARP (MD)
Entity Type:Individual
Prefix:
First Name:KALYANI
Middle Name:KANDARP
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 1:6569 N RIVERSIDE DR # 102504
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-9318
Mailing Address - Country:US
Mailing Address - Phone:559-800-1366
Mailing Address - Fax:
Practice Address - Street 1:500 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5600
Practice Address - Country:US
Practice Address - Phone:559-675-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143815207RG0100X
CAC52409207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE88861Medicare UPIN