Provider Demographics
NPI:1972999142
Name:SHAH, JINESH (MD)
Entity type:Individual
Prefix:
First Name:JINESH
Middle Name:
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 1:780 SWIFT BLVD
Mailing Address - Street 2:KADLEC FAMILY MEDICINE RESIDENCY
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-942-2516
Mailing Address - Fax:509-942-3218
Practice Address - Street 1:780 SWIFT BLVD
Practice Address - Street 2:KADLEC FAMILY MEDICINE RESIDENCY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-942-2516
Practice Address - Fax:509-942-3218
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60568908390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1972999142Medicaid