Provider Demographics
NPI:1104928522
Name:SHEN, JIAN (MD)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17610 BROOKHURST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5097
Mailing Address - Country:US
Mailing Address - Phone:781-883-6391
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE PORTLAND MEDICAL CENTER
Practice Address - Street 2:4805 NE GLISAN ST.
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-9721
Practice Address - Country:US
Practice Address - Phone:503-215-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228443207ZP0102X
ORMD150260207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology