1992783112 NPI number — JOHN SHEN PH.D.

Table of content: JOHN SHEN PH.D. (NPI 1992783112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992783112 NPI number — JOHN SHEN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEN
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992783112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN CARLOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94070-7256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-465-8691
Provider Business Mailing Address Fax Number:
650-802-8195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
536 SKIFF CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94065-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-802-8195
Provider Business Practice Location Address Fax Number:
650-802-8195
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  21811 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 3245 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com