Healthcare Provider Details

I. General information

NPI: 1629129341
Provider Name (Legal Business Name): AMISH AJIT SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/21/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DUBLIN BLVD STE 120
DUBLIN CA
94568-4363
US

IV. Provider business mailing address

3100 DUBLIN BLVD STE 120
DUBLIN CA
94568-4363
US

V. Phone/Fax

Practice location:
  • Phone: 925-556-5800
  • Fax:
Mailing address:
  • Phone: 925-556-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number249421
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD2011-0407
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC149156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: