MEDICARE: KAJAL RAKESH SHAH

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	1223G0001X	General Practice Dentistry	109921	CA

General Provider Information

NPI Number	:	1346009420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAJAL RAKESH SHAH

Provider Business Mailing Address
First Line	:	2140 S SHORE CTR
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-8043
Country	:	US
Telephone Number	:	408-368-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 S SHORE CTR
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-8043
Country	:	US
Telephone Number	:	408-368-4448
Fax Number	:

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	11/18/2024

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Directions to “ KAJAL RAKESH SHAH ” Practice Location

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