Provider Demographics
NPI:1902812159
Name:SHEN, JOHN TZE-CHIANG (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TZE-CHIANG
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27403 YNEZ RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5603
Mailing Address - Country:US
Mailing Address - Phone:951-526-2044
Mailing Address - Fax:951-894-4667
Practice Address - Street 1:27403 YNEZ RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5603
Practice Address - Country:US
Practice Address - Phone:951-526-2044
Practice Address - Fax:951-894-4667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00399725OtherRAILROAD MEDICARE PROVIDER NUMBER
CA00A861000OtherBLUE SHIELD
CAI19373Medicare UPIN
CA00A861000OtherBLUE SHIELD