Basic Information
| Provider Information | |||||||||
| NPI: | 1881988541 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHEN | ||||||||
| FirstName: | JOHNNY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2003 BIRNAM GLEN DR | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774796421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2672319016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 S COLORADO BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802461954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036928000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2011 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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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 | BP10040640 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR0054115 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.