Provider Demographics
NPI:1699783035
Name:SHAH, KIRIT C (MD)
Entity type:Individual
Prefix:DR
First Name:KIRIT
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 1ST AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3919
Mailing Address - Country:US
Mailing Address - Phone:626-445-5577
Mailing Address - Fax:626-445-2155
Practice Address - Street 1:900 S 1ST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3919
Practice Address - Country:US
Practice Address - Phone:626-445-5577
Practice Address - Fax:626-445-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A425360Medicaid
CAC35539Medicare UPIN
CAA42536Medicare ID - Type Unspecified