Provider Demographics
NPI:1215061098
Name:SHEN, WILLIAM (OMD,LAC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:OMD,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 BARBER LN
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7919
Mailing Address - Country:US
Mailing Address - Phone:140-843-2060
Mailing Address - Fax:140-843-2010
Practice Address - Street 1:762 BARBER LN
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7919
Practice Address - Country:US
Practice Address - Phone:140-843-2060
Practice Address - Fax:140-843-2010
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist