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General NPI Number Information
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NPI Number | 1831660588
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Entity Type | Organization
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Legal Business Name | KRUPA SHAH MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1294 W 6TH ST STE 204
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City | SAN PEDRO
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State | CA
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Zip | 90731-2998
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Country | US
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Telephone | 310-832-5331
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Fax | 310-521-0139
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Provider Business Mailing Address
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Address Line | 1294 W 6TH ST STE 204
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City | SAN PEDRO
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State | CA
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Zip | 90731-2998
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Country | US
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Telephone | 310-832-5331
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Fax | 310-521-0139
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KRUPA SHAH
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Credential | MD
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Telephone | 310-832-5331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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