Healthcare Provider Details

I. General information

NPI: 1285662270
Provider Name (Legal Business Name): SHEN MEDICINE & PEDIATRICS ASSOCIATES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 ROSEWOOD AVE
SAN JOSE CA
95117-1605
US

IV. Provider business mailing address

316 ROSEWOOD AVE
SAN JOSE CA
95117-1605
US

V. Phone/Fax

Practice location:
  • Phone: 408-296-9800
  • Fax:
Mailing address:
  • Phone: 408-296-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA54917
License Number StateCA

VIII. Authorized Official

Name: DR. AL SHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 408-296-9800