Healthcare Provider Details

I. General information

NPI: 1306991625
Provider Name (Legal Business Name): JOHN T SHEN MD, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 YNEZ RD SUITE 106
TEMECULA CA
92591-5603
US

IV. Provider business mailing address

27403 YNEZ RD SUITE 106
TEMECULA CA
92591-5603
US

V. Phone/Fax

Practice location:
  • Phone: 951-526-2044
  • Fax: 951-332-9008
Mailing address:
  • Phone: 951-526-2044
  • Fax: 951-332-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA86100
License Number StateCA

VIII. Authorized Official

Name: MRS. KAREN NELSON SHEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-302-0959