Healthcare Provider Details

I. General information

NPI: 1124287768
Provider Name (Legal Business Name): SHAN A NATHAN MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W AVENUE J SUITE 101
LANCASTER CA
93534
US

IV. Provider business mailing address

44215 15TH ST W STE 203
LANCASTER CA
93534-5504
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-8717
  • Fax: 661-945-4867
Mailing address:
  • Phone: 661-726-6599
  • Fax: 661-726-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA31010
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAN A NATHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 991-945-8717