Basic Information
| Provider Information | |||||||||
| NPI: | 1689839631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | KEVAL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34509 9TH AVE S STE 304 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539391230 | ||||||||
| FaxNumber: | 2069331047 | ||||||||
| Practice Location | |||||||||
| Address1: | 34509 9TH AVE S STE 304 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539391230 | ||||||||
| FaxNumber: | 2069331047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 54078-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 54078-20 | WI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0000X | MD60714513 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2046466 | 05 | WA | MEDICAID |