Healthcare Provider Details

I. General information

NPI: 1699090274
Provider Name (Legal Business Name): PAURUSH L SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16671 YORBA LINDA BLVD STE 200
YORBA LINDA CA
92886-2025
US

IV. Provider business mailing address

101 THE CITY DR S
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-996-3700
  • Fax:
Mailing address:
  • Phone: 714-456-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number139280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: