| Organization Name: | SHAH WELLNESS MEDICAL CLINIC INC. |
| NPI Number: | 1720486822 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HITENDRA H SHAH (PRESIDENT) |
| Mailing Address: | 23341 Golden Springs Dr Suite 210 Diamond Bar |
| State: | CA US |
| Postal Code: | 917652058 |
| Phone Number: | 9098602610 |
| Fax Number: | 9098601192 |
| NPI Enumeration Date: | 12/05/2014 |
| NPI Last Update Date: | 12/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A36638 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |