Healthcare Provider Details

I. General information

NPI: 1194017657
Provider Name (Legal Business Name): GOONJAN SUNIL SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MEDICAL CENTER DR
WEST HILLS CA
91307-1907
US

IV. Provider business mailing address

DEPARTMENT OF ANESTHESIOLOGY CB 7010, N2201 UNC HOSPITALS
CHAPEL HILL NC
27599-7010
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax:
Mailing address:
  • Phone: 919-966-5136
  • Fax: 919-966-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number172907
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA136333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: