Provider Demographics
NPI:1285954040
Name:TIAN, SHAOZHOU KEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAOZHOU
Middle Name:KEN
Last Name:TIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 RIVER CREST DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7295
Mailing Address - Country:US
Mailing Address - Phone:501-804-3545
Mailing Address - Fax:
Practice Address - Street 1:6435 RIVER CREST DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-7295
Practice Address - Country:US
Practice Address - Phone:501-804-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program