Provider Demographics
NPI:1013570563
Name:SHAH, VIVEK DILIPKUMAR
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:DILIPKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DR # 2B182
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1438
Mailing Address - Country:US
Mailing Address - Phone:747-210-3205
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 560W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2182
Practice Address - Country:US
Practice Address - Phone:310-453-5654
Practice Address - Fax:310-453-6885
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177519207RX0202X, 207RH0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program