MEDICARE: TARIQ SHAH, M.D., 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	207RN0300X	Nephrology Physician	A66881	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750452116	OTHER	CA	ENTITY TYPE 1 NPI #

General Provider Information

NPI Number	:	1669536975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARIQ SHAH, M.D., INC.

Provider Business Mailing Address
First Line	:	2200 W 3RD ST
Second Line	:	SUITE 500
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-207-5711
Fax Number	:	213-413-0190

Provider Business Practice Location Address
First Line	:	2200 W 3RD ST
Second Line	:	SUITE 500
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-207-5711
Fax Number	:	213-413-0190

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TARIQ SHAH
Credential	:	M.D.
Telephone Number	:	213-207-5711

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/27/2014

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