Healthcare Provider Details

I. General information

NPI: 1699882894
Provider Name (Legal Business Name): NITIN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

16220 RIDGEVIEW LN
LA MIRADA CA
90638-3494
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5991
Mailing address:
  • Phone: 562-902-0277
  • Fax: 714-516-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA49385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: