Active NPI
Pooja V Shah, DDS
- Dentist
- Corona, CA
National Provider Identifier
1124263777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 56936
- Practice address
- 571 Ruth Cir
Corona, CA 92879-8088 - Phone
- (951) 768-8224
- NPI assigned
- Dec 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 56936 | CA | Primary |
Addresses
Primary practice location
571 Ruth Cir
Corona, CA 92879-8088
Mailing address
571 Ruth Cir
Corona, CA 92879-8088
Phone (951) 768-8224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170228000221 | CA | Order and Referring Only - Dentist | 8325322944 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56936 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230076800000",
"number": "1124263777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "571 RUTH CIR",
"city": "CORONA",
"state": "CA",
"postal_code": "928798088",
"telephone_number": "951-768-8224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "571 RUTH CIR",
"city": "CORONA",
"state": "CA",
"postal_code": "928798088",
"telephone_number": "951-768-8224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "POOJA",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-11",
"last_updated": "2008-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "56936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.