Healthcare Provider Details

I. General information

NPI: 1366743437
Provider Name (Legal Business Name): EDWARD N. SHEN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA STREET #701
HONOLULU HI
96813
US

IV. Provider business mailing address

1380 LUSITANA STREET #701
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-587-8200
  • Fax: 808-531-8201
Mailing address:
  • Phone: 808-587-8200
  • Fax: 808-531-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD5430
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD5430
License Number StateHI

VIII. Authorized Official

Name: MR. EDWARD N SHEN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 808-587-8200