MEDICARE: DR. DAVID T. SHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A063555	CA

General Provider Information

NPI Number	:	1235100330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID T. SHEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 828
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-0828
Country	:	US
Telephone Number	:	562-434-7777
Fax Number	:	562-433-3737

Provider Business Practice Location Address
First Line	:	4910 AIRPORT PLAZA DR STE 100
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1377
Country	:	US
Telephone Number	:	562-434-7777
Fax Number	:	562-433-3737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	10/26/2020

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Directions to “ DR. DAVID T. SHEN M.D.” Practice Location

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