MEDICARE: SHAH & KHEDIA MEDICAL DOCTORS INC

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	207RN0300X	Nephrology Physician	A42703	CA
2	207R00000X	Internal Medicine Physician	A56166	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FNP39178	OTHER	CA	MEDICAL BOARD OF CA FICTITIOUS NAME PERMIT

General Provider Information

NPI Number	:	1770715104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAH & KHEDIA MEDICAL DOCTORS INC

Provider Business Mailing Address
First Line	:	18335 VALLEY BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5968
Country	:	US
Telephone Number	:	626-810-3330
Fax Number	:	626-964-0440

Provider Business Practice Location Address
First Line	:	18335 VALLEY BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5968
Country	:	US
Telephone Number	:	626-810-3330
Fax Number	:	626-964-0440

Authorized Official
Title or Position	:	OWNER
Name	:	HIREN C SHAH
Credential	:	MD
Telephone Number	:	626-810-3330

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/18/2009

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