MEDICARE: BHAVI SHAH DDS, INC

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	D55565	CA

General Provider Information

NPI Number	:	1366808479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHAVI SHAH DDS, INC

Provider Business Mailing Address
First Line	:	13300 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2969
Country	:	US
Telephone Number	:	562-863-9396
Fax Number	:	562-864-7436

Provider Business Practice Location Address
First Line	:	13300 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-2969
Country	:	US
Telephone Number	:	562-863-9396
Fax Number	:	562-864-7436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BHAVI SHAH
Credential	:	DDS
Telephone Number	:	714-467-8587

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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