Provider Demographics
NPI:1902041643
Name:SHAH, SOORAJ M
Entity type:Individual
Prefix:DR
First Name:SOORAJ
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 NEWPORT BLVD STE 445
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7730
Mailing Address - Country:US
Mailing Address - Phone:714-241-9070
Mailing Address - Fax:949-889-2260
Practice Address - Street 1:1640 NEWPORT BLVD STE 445
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-7730
Practice Address - Country:US
Practice Address - Phone:714-241-9070
Practice Address - Fax:949-889-2260
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276483207RA0002X, 207RC0000X, 207RI0011X
CAC170604207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology