Healthcare Provider Details

I. General information

NPI: 1922014851
Provider Name (Legal Business Name): SAMIR BIPIN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LENNON LANE SUITE 201
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

301 LENNON LANE SUITE 201
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-6100
  • Fax: 925-932-1160
Mailing address:
  • Phone: 925-296-6100
  • Fax: 925-646-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA68255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: