Provider Demographics
NPI:1740308592
Name:SHAH, NIMEESH K (MD)
Entity type:Individual
Prefix:
First Name:NIMEESH
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S. BASCOM AVENUE
Mailing Address - Street 2:SANTA CLARA VALLEY MEDICAL CENTER
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-7947
Mailing Address - Fax:
Practice Address - Street 1:751 S. BASCOM AVENUE
Practice Address - Street 2:SANTA CLARA VALLEY MEDICAL CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117494207R00000X
CAA104433207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine