Healthcare Provider Details

I. General information

NPI: 1659459220
Provider Name (Legal Business Name): BINDESH A. SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S HARBOR BLVD SUITE A
LA HABRA CA
90631-7577
US

IV. Provider business mailing address

1400 S HARBOR BLVD SUITE A
LA HABRA CA
90631-7577
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-3400
  • Fax:
Mailing address:
  • Phone: 714-879-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA87556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: