Healthcare Provider Details

I. General information

NPI: 1851465504
Provider Name (Legal Business Name): UMESH SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 10TH ST STE B
CHINO CA
91710-3503
US

IV. Provider business mailing address

12540 10TH ST STE B
CHINO CA
91710-3503
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-6414
  • Fax:
Mailing address:
  • Phone: 909-591-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA34147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: