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General NPI Number Information
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NPI Number | 1598946576
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Entity Type | Organization
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Legal Business Name | JEANNIE SHEN,MD INC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 625 FAIR OAKS AVE SUITE 300
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City | PASADENA
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State | CA
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Zip | 91105-2640
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Country | US
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Telephone | 626-356-3167
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Fax | 626-356-9190
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Provider Business Mailing Address
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Address Line | 625 S FAIR OAKS AVE SUITE 300
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City | PASADENA
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State | CA
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Zip | 91105-2640
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Country | US
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Telephone | 626-356-3167
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Fax | 626-356-9190
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JEANNIE SHEN
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Credential | M.D.
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Telephone | 626-356-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | A70643
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License Number State | CA
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