Individual
NIKITA MUKESH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
425 HAALAND DR STE 101, THOUSAND OAKS, CA 91361-5230
(805) 496-2949
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301112575
MI
208600000X
Surgery Physician
R7322
TX
2086X0206X
Surgical Oncology Physician
Primary
A170065
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387124602
—
TX
Enumeration date
03/23/2012
Last updated
11/11/2020
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