Provider Demographics
NPI:1457923658
Name:SHAH, KARISHMA ASHOK
Entity type:Individual
Prefix:
First Name:KARISHMA
Middle Name:ASHOK
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16603 WEATHERLY CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8239
Mailing Address - Country:US
Mailing Address - Phone:908-335-7251
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 400B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7081
Practice Address - Country:US
Practice Address - Phone:661-630-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106773122300000X
IL019.0330321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice