Healthcare Provider Details

I. General information

NPI: 1285998609
Provider Name (Legal Business Name): NIHAR U SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TELEGRAPH AVE
BERKELEY CA
94705
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8120
  • Fax: 510-506-7721
Mailing address:
  • Phone: 510-204-8120
  • Fax: 510-506-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA133210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number989517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: