Provider Demographics
NPI:1932216025
Name:SHAH, SULTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SULTAN
Middle Name:
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 1:710 N EUCLID ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4115
Mailing Address - Country:US
Mailing Address - Phone:714-533-4511
Mailing Address - Fax:714-517-2197
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4115
Practice Address - Country:US
Practice Address - Phone:714-533-4511
Practice Address - Fax:714-517-2197
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341350Medicaid
109-532-2OtherECFMG NUMBER
109-532-2OtherECFMG NUMBER
CAA27384Medicare UPIN