Nicole Kristine Shah-Ghassemzadeh, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

13979 Issued in CA

Practice address

Jerry L. Pettis Memorial Veterans Hospital - Gastroente
11201 Benton Street
Loma Linda, CA 92357

Phone

(909) 558-4000

NPI assigned

Apr 16, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Nicole Kristine Shah Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1679916027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "JERRY L. PETTIS MEMORIAL VETERANS HOSPITAL - GASTROENTE",
            "address_2": "11201 BENTON STREET",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92357",
            "telephone_number": "909-558-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "JERRY L. PETTIS MEMORIAL VETERANS HOSPITAL - GASTROENTE",
            "address_2": "11201 BENTON STREET",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92357",
            "telephone_number": "909-558-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH-GHASSEMZADEH",
        "first_name": "NICOLE",
        "middle_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "13979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SHAH",
            "middle_name": "KRISTINE",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jon Wyott Sevick
• Katelyn Anna Seward, DO
• Nellie Rising Sgambelluri, M.D.
• Parvaneh Shadkam-Farrokhi, MD
• Ariel Shafa, DO
• Krupa Mayur Shah-Singh, DO, MS
• Amul Shah
• Anup Shah, M.D.
• Hetavi Shah
• Jason R Shah, MD

• Internal Medicine Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.