Shivam Patel

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

110349 Issued in CA

Practice address

6090 Redwood Blvd
Novato, CA 94945-4569

Phone

(415) 448-1500

NPI assigned

Feb 28, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1700532702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6090 REDWOOD BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454569",
            "telephone_number": "415-448-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHIVAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-28",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "110349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Parry
• Monica Marziyeh Parsad, PHARMD
• Lisa C Pasquinelli, PH.D.
• Oona Patchen, MS
• Neal Patel, D.D.S.
• Robert Joseph Patocchi, M.D.
• Jill Nicole Peeler
• Edward Kevin Penafiel
• Robin Beth Pence
• Cinthya Jajayra Perez Rivera

• General Practice Dentistry in Novato, CA
• Providers in Novato, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.