MEDICARE: HARSHAD SHAH MD A PROFESSIONAL CORPORATION

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	2084P0800X	Psychiatry Physician	A53132	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336263011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARSHAD SHAH MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	9648 SEVILLE WAY
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-6804
Country	:	US
Telephone Number	:	310-867-3493
Fax Number	:	714-236-4199

Provider Business Practice Location Address
First Line	:	1533 ALAMITOS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2214
Country	:	US
Telephone Number	:	310-867-3493
Fax Number	:	714-236-4199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARSHAD SHAH
Credential	:	M.D
Telephone Number	:	310-867-3493

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	12/07/2011

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