Provider Demographics
NPI:1649264060
Name:SHAH, HARISH G (MD)
Entity type:Individual
Prefix:
First Name:HARISH
Middle Name:G
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARISH
Other - Middle Name:G
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2611 N DINUBA BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9003
Mailing Address - Country:US
Mailing Address - Phone:559-733-6342
Mailing Address - Fax:550-740-4420
Practice Address - Street 1:2611 N DINUBA BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9003
Practice Address - Country:US
Practice Address - Phone:559-733-6342
Practice Address - Fax:550-740-4420
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84747207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH98965Medicare UPIN
CA00A847471Medicare ID - Type Unspecified