Provider Demographics
NPI:1215016175
Name:SHEN, RONG (MD)
Entity Type:Individual
Prefix:DR
First Name:RONG
Middle Name:
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 1:728 PACIFIC AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4457
Mailing Address - Country:US
Mailing Address - Phone:415-596-3211
Mailing Address - Fax:415-398-5580
Practice Address - Street 1:728 PACIFIC AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4457
Practice Address - Country:US
Practice Address - Phone:415-596-3211
Practice Address - Fax:415-398-5580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81146207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA81146Other1
CA00A811460Other1
CA00A811460Medicaid
CA731678750Other1
CA731678750Other1
CAH81153Medicare UPIN