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General NPI Number Information
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NPI Number | 1992755946
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Entity Type | Individual
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Provider Name | KENNETH JAYENDRA SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 2465 W HORIZON RIDGE PKWY SUITE 100
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City | HENDERSON
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State | NV
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Zip | 89052-5952
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Country | US
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Telephone | 702-616-0500
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Fax | 702-616-0505
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Provider Business Mailing Address
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Address Line | 700 E SILVERADO RANCH BLVD STE 170
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City | LAS VEGAS
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State | NV
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Zip | 89183-7518
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Country | US
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Telephone | 702-240-6482
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 8591
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License Number State | NV
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