Provider Demographics
NPI:1699092692
Name:CHUNILAL SHAH MD INC
Entity type:Organization
Organization Name:CHUNILAL SHAH MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-947-1619
Mailing Address - Street 1:15651 IMPERIAL HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15651 IMPERIAL HWY STE 104
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1600
Practice Address - Country:US
Practice Address - Phone:562-947-1619
Practice Address - Fax:562-947-5969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHUNILAL SHAH MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33116208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33116Medicare PIN