NPIMap

Organization Active NPI

Dr Srujal H Shah DDS Inc

  • Dentist
  • San Ramon, CA
National Provider Identifier
1801286505
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
58754 Issued in CA
Legal business name
DR SRUJAL H SHAH DDS INC
Practice address
1081 Market PL
Ste 100
San Ramon, CA 94583-4749
Phone
(408) 490-0182
Fax
(408) 624-4545
NPI assigned
Feb 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Authorized official

Name
Srujal Harshad Shah, D.D.S.NPI 1457684623
Title
President
Phone
(408) 490-0182

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 58754 CA Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1081 Market PL
Ste 100
San Ramon, CA 94583-4749

Mailing address

6120 Hellyer Ave Ste 125
San Jose, CA 95138-1066
Phone (408) 490-0182

Other names 1

  • Spark Sleep Solutions Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170504000050 CA DME Supplier - Oral Surgery - Dentist 4486840634 Practice locations: San Ramon, CA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dr Srujal H Shah DDS Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1665 Dominican Way
Ste 224
Santa Cruz, CA 95065
Phone (831) 246-8772

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1801286505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 HELLYER AVE STE 125",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951381066",
            "telephone_number": "408-490-0182",
            "fax_number": "408-624-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1081 MARKET PL",
            "address_2": "STE 100",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945834749",
            "telephone_number": "408-490-0182",
            "fax_number": "408-624-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SRUJAL H SHAH DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-02",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SRUJAL",
        "authorized_official_middle_name": "HARSHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "408-490-0182",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "58754",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spark Sleep Solutions",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spark Sleep Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Ramon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.