MEDICARE: JHANKHANA MUKESH 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	DDS64952	CA

General Provider Information

NPI Number	:	1831610575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHANKHANA MUKESH SHAH

Provider Business Mailing Address
First Line	:	2 UNION SQ
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-489-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 UNION SQ
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-489-5000
Fax Number	:	510-489-5000

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/03/2017

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