Healthcare Provider Details

I. General information

NPI: 1053766600
Provider Name (Legal Business Name): JESSICA SHUEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W STETSON AVE STE B
HEMET CA
92543-7311
US

IV. Provider business mailing address

1708 S TREMONT ST
OCEANSIDE CA
92054-5309
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA158830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: