MEDICARE: JEN-KWAY 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	174400000X	Specialist	A44321	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A44321	OTHER	CA	PRIVATE INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740242874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEN-KWAY SHEN M.D.

Provider Business Mailing Address
First Line	:	1629 SIALIC PL
Second Line	:
City	:	LA HABRA HEIGHTS
State	:	CA
Zip	:	90631-8088
Country	:	US
Telephone Number	:	626-854-2828
Fax Number	:	626-854-2829

Provider Business Practice Location Address
First Line	:	1850 S AZUSA AVE
Second Line	:
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-6813
Country	:	US
Telephone Number	:	626-854-2828
Fax Number	:	626-854-2829

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	12/28/2016

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Directions to “ JEN-KWAY SHEN M.D.” Practice Location

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