Provider Demographics
NPI:1811970726
Name:SHAH, M. MOHSIN (MD)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:MOHSIN
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 1:999 N TUSTIN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3528
Mailing Address - Country:US
Mailing Address - Phone:949-870-9784
Mailing Address - Fax:949-284-0604
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3528
Practice Address - Country:US
Practice Address - Phone:949-870-9784
Practice Address - Fax:949-284-0604
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60010649207T00000X
MN1034632084V0102X
FLME110039207T00000X
KY43336207T00000X
CAA066315207T00000X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A663150Medicaid
OR277926Medicaid
CA00A663150OtherBLUE SHIELD
CA00A663150Medicaid
CA00A663150OtherBLUE SHIELD
CAWA66315AMedicare PIN