Provider Demographics
NPI:1285662270
Name:SHEN MEDICINE & PEDIATRICS ASSOCIATES A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SHEN MEDICINE & PEDIATRICS ASSOCIATES A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-296-9800
Mailing Address - Street 1:316 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1605
Mailing Address - Country:US
Mailing Address - Phone:408-296-9800
Mailing Address - Fax:
Practice Address - Street 1:316 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1605
Practice Address - Country:US
Practice Address - Phone:408-296-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54917261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75131Medicare UPIN