Provider Demographics
NPI:1831326479
Name:SHAH, ASHISH MAHENDRA (DO)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:MAHENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 550
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3687
Mailing Address - Country:US
Mailing Address - Phone:949-770-6252
Mailing Address - Fax:949-770-1124
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:STE 550
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-770-6252
Practice Address - Fax:949-770-1124
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16638207RC0001X
NJ25MB09113500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty