NPIMap

Organization Active NPI

Jayshree N. Shah DDS, Inc.

Doing business as Vivid Dental Studio

  • General Practice Dentistry
  • Fullerton, CA
National Provider Identifier
1114176609
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
34900 Issued in CA
Legal business name
JAYSHREE N. SHAH DDS, INC.
Doing business as
Vivid Dental Studio
Practice address
301 W Bastanchury Rd Ste 5
Fullerton, CA 92835-3422
Phone
(714) 871-4892
Fax
(714) 871-4896
NPI assigned
Sep 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tejas Shah
Title
Secretary
Phone
(714) 871-4892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 34900 CA Primary

Addresses

Primary practice location

301 W Bastanchury Rd Ste 5
Fullerton, CA 92835-3422

Mailing address

301 W Bastanchury Rd Ste 5
Fullerton, CA 92835-3422

Other names 1

  • Vivid Dental Studio Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jayshree N Shah DDS Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1114176609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W BASTANCHURY RD STE 5",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W BASTANCHURY RD STE 5",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353422",
            "telephone_number": "714-871-4892",
            "fax_number": "714-871-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAYSHREE N. SHAH DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "TEJAS",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-871-4892"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "34900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vivid Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.