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General NPI Number Information
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NPI Number | 1194005397
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Entity Type | Individual
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Provider Name | CHAITALI SHAH O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 5520 WHITTIER BLVD
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City | COMMERCE
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State | CA
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Zip | 90022-4104
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Country | US
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Telephone | 323-728-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 17327 LARISA DR
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City | CERRITOS
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State | CA
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Zip | 90703-2770
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Country | US
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Telephone | 562-215-3858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14176
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License Number State | CA
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