Provider Demographics
NPI:1649604935
Name:VIKRAMKUMAR H SHAH D.D.S INC
Entity type:Organization
Organization Name:VIKRAMKUMAR H SHAH D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-365-0605
Mailing Address - Street 1:907 TRUMAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3316
Mailing Address - Country:US
Mailing Address - Phone:818-365-0605
Mailing Address - Fax:818-365-5305
Practice Address - Street 1:907 TRUMAN ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3316
Practice Address - Country:US
Practice Address - Phone:818-365-0605
Practice Address - Fax:818-365-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932317005OtherDENTICAL