Provider Demographics
NPI:1194711895
Name:SHAW, LEIN-CHUN (MD)
Entity type:Individual
Prefix:
First Name:LEIN-CHUN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEIN-CHUN
Other - Middle Name:
Other - Last Name:HSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10513 SILVERDALE WAY NW
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9499
Mailing Address - Country:US
Mailing Address - Phone:360-692-5353
Mailing Address - Fax:360-692-2409
Practice Address - Street 1:10513 SILVERDALE WAY NW
Practice Address - Street 2:SUITE 109
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9499
Practice Address - Country:US
Practice Address - Phone:360-692-5353
Practice Address - Fax:360-692-2409
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00016247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1289701Medicaid
WAA06993Medicare UPIN