Healthcare Provider Details

I. General information

NPI: 1114102969
Provider Name (Legal Business Name): KANDARP K. SHAH, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N COURT ST STE B
VISALIA CA
93291-4920
US

IV. Provider business mailing address

6569 N RIVERSIDE DR # 102504
FRESNO CA
93722-9318
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-9100
  • Fax:
Mailing address:
  • Phone: 559-625-9100
  • Fax: 559-625-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KANDARP K SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-625-9100