MEDICARE: JIAN SHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	228443	MA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD150260	OR

General Provider Information

NPI Number	:	1104928522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIAN SHEN M.D.

Provider Business Mailing Address
First Line	:	17610 BROOKHURST DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-5097
Country	:	US
Telephone Number	:	781-883-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	PROVIDENCE PORTLAND MEDICAL CENTER
Second Line	:	4805 NE GLISAN ST.
City	:	PORTLAND
State	:	OR
Zip	:	97213-9721
Country	:	US
Telephone Number	:	503-215-2218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/09/2023

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