Kushan Ketan Shah

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA63312 Issued in CA

Practice address

1300 E Cooley Dr
Colton, CA 92324-3905

Phone

(909) 370-4100

NPI assigned

Oct 3, 2022

Sex

Male

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Maryland School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Livingwater'S Medical Clinic, Inc.Group PAC ID 6204849102, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kshah30897@epiclp.direct-ci.com
• Direct secure messaging: kushan.shah@111500147032068.direct.elationemr.com

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.

• Beaver Medical Group P C

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment Care Compare group NPD
• Livingwater'S Medical Clinic, Inc.

  • Primary Care Clinic/Center
  • Murrieta, CA
  • NPI 1992738991
  Medicare reassignment Care Compare group NPD
• Healthcare Partners Affiliates Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Cassidy Medical Group Inc.

  • Multi-Specialty Clinic/Center
  • Vista, CA
  • NPI 1215003470
  NPD
• Centers for Family Medicine GP

  • Family Medicine Physician
  • Los Alamitos, CA
  • NPI 1467598243
  NPD
• Healthcare Partners Affiliates Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1750005849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E COOLEY DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243905",
            "telephone_number": "909-370-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24910 Las Brisas Rd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925624010",
            "country_code": "US",
            "telephone_number": "951-694-8549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "KUSHAN",
        "middle_name": "KETAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Serpas
• Berenice Serrano
• Marco Serrano, PA-C
• Michael Sewell
• Stephen Faraz Shafizadeh, MD PHD DC
• Zanab Shahbuddin, MD
• Kristina Shahriari, M.D., PH.D.
• Lubna A. Shakir, D.O.
• Sean Shargh, D.O.
• Akbar Sharip, MD, MPH

• Physician Assistant in Colton, CA
• Providers in Colton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.