Healthcare Provider Details

I. General information

NPI: 1215016175
Provider Name (Legal Business Name): RONG SHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/09/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 PACIFIC AVE SUITE 606
SAN FRANCISCO CA
94133-4457
US

IV. Provider business mailing address

728 PACIFIC AVE SUITE 606
SAN FRANCISCO CA
94133-4457
US

V. Phone/Fax

Practice location:
  • Phone: 415-596-3211
  • Fax: 415-398-5580
Mailing address:
  • Phone: 415-596-3211
  • Fax: 415-398-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA81146
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA81146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: