Provider Demographics
NPI:1770557480
Name:SHAH, KASHMIRA M (MD)
Entity type:Individual
Prefix:
First Name:KASHMIRA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:951-925-3606
Practice Address - Street 1:850 E LATHAM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4391
Practice Address - Country:US
Practice Address - Phone:951-929-6988
Practice Address - Fax:951-766-1269
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA318212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318211Medicaid
CA00A318211Medicaid
CA00A318211Medicaid