MEDICARE: KUSHAN K SHAH

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	1223G0001X	General Practice Dentistry	11878	CT

General Provider Information

NPI Number	:	1134648660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUSHAN K SHAH

Provider Business Mailing Address
First Line	:	227 N TALBERT BLVD
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-4142
Country	:	US
Telephone Number	:	336-249-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 N TALBERT BLVD
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-4142
Country	:	US
Telephone Number	:	336-249-2906
Fax Number	:

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

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	05/19/2026

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