Healthcare Provider Details

I. General information

NPI: 1891908398
Provider Name (Legal Business Name): KUMAR C SHAH BDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ SUITE 350
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

10833 LE CONTE AVE B3-087 CHS
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-5750
  • Fax: 310-208-0786
Mailing address:
  • Phone: 310-206-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberSP237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS103505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: