Healthcare Provider Details

I. General information

NPI: 1518800226
Provider Name (Legal Business Name): BHAVIK SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 TIVERTON AVE
LOS ANGELES CA
90095-8361
US

IV. Provider business mailing address

21781 VENTURA BLVD # 238
WOODLAND HILLS CA
91364-1835
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: