Provider Demographics
NPI:1316367154
Name:SHAN, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4509
Mailing Address - Country:US
Mailing Address - Phone:714-456-5631
Mailing Address - Fax:714-285-0389
Practice Address - Street 1:1102 BATES AVE # FC1860
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2617
Practice Address - Country:US
Practice Address - Phone:832-824-5447
Practice Address - Fax:832-824-0341
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics