Active NPI
Pravin Shah, MD
- Specialist
- Newport Beach, CA
National Provider Identifier
1679613368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- C37705
- Practice address
- 1 Hoag Dr
Newport Beach, CA 92663-4162 - Phone
- (949) 764-8123
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | C37705 | CA | Primary |
Addresses
Primary practice location
1 Hoag Dr
Newport Beach, CA 92663-4162
Mailing address
PO Box 3567
Dana Point, CA 92629-8567
Phone (949) 764-8123
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C37705 | Other | CA | MEDICAL LICENSE |
| 11420405 | Other | SOCIAL SECURITY NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1679613368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3567",
"city": "DANA POINT",
"state": "CA",
"postal_code": "926298567",
"telephone_number": "949-764-8123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 HOAG DR",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926634162",
"telephone_number": "949-764-8123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "PRAVIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "C37705",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "C37705",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL SECURITY NUMBER",
"identifier": "11420405",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.