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General NPI Number Information
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NPI Number | 1861637381
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Entity Type | Organization
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Legal Business Name | DR. SHAN PSYCHIATRY CLINIC LLC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 756 ADAMS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2330
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Country | US
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Telephone | 215-533-3660
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Fax | 215-533-3682
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Provider Business Mailing Address
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Address Line | 756 ADAMS AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2330
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Country | US
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Telephone | 215-533-3660
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Fax | 215-533-3682
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Authorized Official
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Title or Position | DIRECTOR
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Name | YANG SHAN
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Credential | M.D.
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Telephone | 215-533-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | MD421627
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License Number State | PA
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