Healthcare Provider Details

I. General information

NPI: 1093957474
Provider Name (Legal Business Name): SHAWN MICHAEL KREINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DRESDEN DR
LINCOLN CA
95648-8803
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD #100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-543-5500
  • Fax:
Mailing address:
  • Phone: 866-681-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRS2009-0296
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 118510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: