MEDICARE: KRISTEN SHEN

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	1223P0300X	Periodontics	RES-30747	IA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1316737927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SHEN

Provider Business Mailing Address
First Line	:	801 NEWTON RD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-8004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4124
Country	:	US
Telephone Number	:	702-774-5134
Fax Number	:

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

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	06/29/2026

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Directions to “ KRISTEN SHEN ” Practice Location

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