Provider Demographics
NPI:1588916985
Name:HARSHAD R SHAH., M.D. INC
Entity type:Organization
Organization Name:HARSHAD R SHAH., M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARSHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-847-2576
Mailing Address - Street 1:17822 BEACH BLVED, SUITE 218
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7191
Mailing Address - Country:US
Mailing Address - Phone:714-847-2576
Mailing Address - Fax:714-842-2593
Practice Address - Street 1:17822 BEACH BLVD STE 218
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7191
Practice Address - Country:US
Practice Address - Phone:714-847-2576
Practice Address - Fax:714-842-2593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARSHAD R SHAH. M.D.INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38627207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty