MEDICARE: DR. AMIT D SHAH D.D.S

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	59819	CA

General Provider Information

NPI Number	:	1437466406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT D SHAH D.D.S

Provider Business Mailing Address
First Line	:	2821 S HOOVER ST APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2449
Country	:	US
Telephone Number	:	323-578-7516
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 S HOOVER ST APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2449
Country	:	US
Telephone Number	:	323-578-7516
Fax Number	:

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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