Provider Demographics
NPI:1265755086
Name:UMESH C SHAH MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:UMESH C SHAH MD A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-591-6414
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:909-628-1405
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:909-628-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34147207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty