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General NPI Number Information
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NPI Number | 1407078215
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Entity Type | Individual
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Provider Name | NISSAR SHAH M.D
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 300 HILLMONT AVE STE 401
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City | VENTURA
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State | CA
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Zip | 93003-1651
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Country | US
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Telephone | 805-648-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 3265 S. SEPULVEDA BLVD. #208
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City | LOS ANGELES
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State | CA
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Zip | 90034
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Country | US
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Telephone | 310-390-9317
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Fax | 310-423-0440
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A84201
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License Number State | CA
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