Healthcare Provider Details

I. General information

NPI: 1598996464
Provider Name (Legal Business Name): NEIL KULIN SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR. ROOM H-1402 M/C 5626
STANFORD CA
94305-5626
US

IV. Provider business mailing address

300 PASTEUR DR. ROOM H-1402 M/C 5626
STANFORD CA
94305-5626
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-1981
  • Fax:
Mailing address:
  • Phone: 650-725-1981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA124532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: