MEDICARE: DR. NEHAL M SHAH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	107642	CA

General Provider Information

NPI Number	:	1083349914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEHAL M SHAH DMD

Provider Business Mailing Address
First Line	:	614 WILLOW BEND CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3700
Country	:	US
Telephone Number	:	408-533-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2531 EL CAMINO REAL
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3812
Country	:	US
Telephone Number	:	650-880-1550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	01/04/2023

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