Provider Demographics
NPI:1316129109
Name:SHAH, PRIYA KHANIJOU (MD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:KHANIJOU
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 W LA VETA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4403
Mailing Address - Country:US
Mailing Address - Phone:714-771-5700
Mailing Address - Fax:714-771-9979
Practice Address - Street 1:725 W LA VETA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4403
Practice Address - Country:US
Practice Address - Phone:714-771-5700
Practice Address - Fax:714-771-9979
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB205938Medicare PIN