Provider Demographics
NPI:1730266990
Name:ALFRED C SHEN MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALFRED C SHEN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-895-0639
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0217
Mailing Address - Country:US
Mailing Address - Phone:760-895-0639
Mailing Address - Fax:760-423-6339
Practice Address - Street 1:72780 COUNTRY CLUB DR STE A104
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-895-0639
Practice Address - Fax:760-423-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52041207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A520411OtherMEDICARE
CAA52041OtherCA MEDICAL LICENSE
CAZZZ26188ZMedicare ID - Type UnspecifiedMC GROUP NUMBER
CAG70486Medicare UPIN
CA=========OtherBLUE CROSS ID NUMBER