Provider Demographics
NPI:1720346570
Name:SHUKLA DIXIT, PRACHI (MD)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:SHUKLA DIXIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRACHI
Other - Middle Name:
Other - Last Name:SHUKLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:650-934-7000
Mailing Address - Fax:
Practice Address - Street 1:15400 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2502
Practice Address - Country:US
Practice Address - Phone:408-730-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0800959922390200000X
CAA128297207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program