MEDICARE: MR. JENTA 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	A30257	CA
2	207VG0400X	Gynecology Physician	A30257	CA
3	207VX0201X	Gynecologic Oncology Physician	A30257	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881692002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JENTA SHEN M.D.

Provider Business Mailing Address
First Line	:	1 SHRADER STREET, #400
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1035
Country	:	US
Telephone Number	:	415-668-0900
Fax Number	:	415-668-0950

Provider Business Practice Location Address
First Line	:	1 SHRADER STREET, #400
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-1035
Country	:	US
Telephone Number	:	415-668-0900
Fax Number	:	415-668-0950

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/05/2021

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Directions to “ MR. JENTA SHEN M.D.” Practice Location

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