Healthcare Provider Details

I. General information

NPI: 1144154972
Provider Name (Legal Business Name): CHACE SHAW, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BURGESS DR STE 150
MENLO PARK CA
94025-3475
US

IV. Provider business mailing address

445 BURGESS DR STE 150
MENLO PARK CA
94025-3475
US

V. Phone/Fax

Practice location:
  • Phone: 650-427-0112
  • Fax: 650-820-6775
Mailing address:
  • Phone: 650-427-0112
  • Fax: 650-820-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHACE SHAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-427-0112