MEDICARE: CHANDRAKANT V SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	C51128	CA

General Provider Information

NPI Number	:	1114939105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRAKANT V SHAH M.D.

Provider Business Mailing Address
First Line	:	1555 VIVALDI ST
Second Line	:
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-2346
Country	:	US
Telephone Number	:	858-922-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 VIVALDI ST
Second Line	:
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-2346
Country	:	US
Telephone Number	:	760-633-3044
Fax Number	:	760-633-3044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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