=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447962774
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISHA SAMEER SHAH DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2022
-----------------------------------------------------
Last Update Date | 06/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2825 EL CAMINO REAL
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-343-4167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1455 MCCANDLESS DR APT 355
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035-8223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-402-6894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 111577
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------