Healthcare Provider Details

I. General information

NPI: 1760501795
Provider Name (Legal Business Name): THOMAS A SHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 S RAINBOW BLVD SUITE 107
LAS VEGAS NV
89146-4005
US

IV. Provider business mailing address

2626 S RAINBOW BLVD SUITE 107
LAS VEGAS NV
89146-4005
US

V. Phone/Fax

Practice location:
  • Phone: 702-370-5430
  • Fax: 702-675-4501
Mailing address:
  • Phone: 702-370-5430
  • Fax: 702-675-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9129
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9129
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number9129
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0056727
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: