Provider Demographics
NPI:1306991625
Name:JOHN T SHEN MD, CORP
Entity type:Organization
Organization Name:JOHN T SHEN MD, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-302-0959
Mailing Address - Street 1:27403 YNEZ RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5603
Mailing Address - Country:US
Mailing Address - Phone:951-526-2044
Mailing Address - Fax:951-332-9008
Practice Address - Street 1:27403 YNEZ RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5603
Practice Address - Country:US
Practice Address - Phone:951-526-2044
Practice Address - Fax:951-332-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A861000OtherBLUESHIELD
CAP00399725OtherRAILROAD MEDICARE PTAN
CADF8874OtherRAILROAD MEDICARE GROUP
CAZZZ04178ZMedicare PIN
CAI19373Medicare UPIN