Healthcare Provider Details

I. General information

NPI: 1851222491
Provider Name (Legal Business Name): HAZOOR SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S WASHINGTON ST
LODI CA
95240-5947
US

IV. Provider business mailing address

1321 S WASHINGTON ST
LODI CA
95240-5947
US

V. Phone/Fax

Practice location:
  • Phone: 209-280-5372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: