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General NPI Number Information
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NPI Number | 1629671193
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Entity Type | Individual
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Provider Name | JENNY SOO-JIN SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 11311 BANDERA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78250-6812
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Country | US
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Telephone | 210-682-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 8245 COLONIAL WOODS
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City | BOERNE
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State | TX
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Zip | 78015-4941
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Country | US
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Telephone | 956-909-0124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 49399
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License Number State | TX
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