Healthcare Provider Details

I. General information

NPI: 1386083723
Provider Name (Legal Business Name): JENNIFER I HSUAN SHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 MONTECITO DR
SAN MARINO CA
91108-1207
US

IV. Provider business mailing address

1500 LEXINGTON AVE APT 16D
NEW YORK NY
10029-7357
US

V. Phone/Fax

Practice location:
  • Phone: 716-548-7370
  • Fax:
Mailing address:
  • Phone: 716-548-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number0
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: