Basic Information
| Provider Information | |||||||||
| NPI: | 1700474608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HONG SHEN MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 GANNET LN | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498786278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495612 | ||||||||
| FaxNumber: | 6619495904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2021 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | SHEN | ||||||||
| AuthorizedOfficialFirstName: | HONG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9498786278 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.