Kosha Shah, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

49804 Issued in CA

Practice address

521 W Channel Islands Blvd Ste 8
Port Hueneme, CA 93041-2132

Phone

(805) 815-4356

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• K J Shah DDS, Inc.

  • General Practice Dentistry
  • Port Hueneme, CA
  • NPI 1922139641
  NPD (past) Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669503397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W CHANNEL ISLANDS BLVD STE 8",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412132",
            "telephone_number": "805-815-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W CHANNEL ISLANDS BLVD STE 8",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412132",
            "telephone_number": "805-815-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KOSHA",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "49804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "D49804",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Ruiz
• Ruben R Salcedo
• Marites Garma Salinda
• Heidi Sarte, PHARM. D
• Seth T. Secrease, IDC
• Rutu Jignesh Shah, DDS
• Alireza M Sharifzadeh, DDS
• Shoreline ABA
• Silver Strand Optometry Corp
• Jerry M Smith Jr., IDC

• Dentist in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.