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General NPI Number Information
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NPI Number | 1720486822
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Entity Type | Organization
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Legal Business Name | SHAH WELLNESS MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 23341 GOLDEN SPRINGS DR SUITE 210
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2058
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Country | US
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Telephone | 909-860-2610
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Fax | 909-860-1192
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Provider Business Mailing Address
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Address Line | 23341 GOLDEN SPRINGS DR SUITE 210
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2058
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Country | US
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Telephone | 909-860-2610
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Fax | 909-860-1192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HITENDRA H SHAH
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Credential | M.D.
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Telephone | 909-860-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A36638
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License Number State | CA
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