MEDICARE: HAI SHAO MD. PHD, A MEDICAL CORPORATION

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	207RI0200X	Infectious Disease Physician	A79601	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912178237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAI SHAO MD. PHD, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3525 DEL MAR HEIGHTS RD # 806
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	619-567-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 DEL MAR HEIGHTS RD # 806
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	619-567-3205
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAI SHAO
Credential	:	MD. PH.D
Telephone Number	:	619-567-3205

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	12/18/2014

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