Healthcare Provider Details

I. General information

NPI: 1750452116
Provider Name (Legal Business Name): TARIQ SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 7TH ST STE S270
LOS ANGELES CA
90017-3977
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 213-409-6686
  • Fax: 213-988-8390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA66881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: