Basic Information
| Provider Information | |||||||||
| NPI: | 1497927834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REID | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5977 E SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908083752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624213727 | ||||||||
| FaxNumber: | 5624208948 | ||||||||
| Practice Location | |||||||||
| Address1: | 5977 E SPRING ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908083752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624213727 | ||||||||
| FaxNumber: | 5624208948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A98398 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A98398 | 01 | CA | CALIFORNIA STATE LICENSE | OTHER |