Provider Demographics
NPI:1346516622
Name:SHAO, CHENGQUN (MD)
Entity Type:Individual
Prefix:
First Name:CHENGQUN
Middle Name:
Last Name:SHAO
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 1:11600 INDIAN HILLS RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1225
Mailing Address - Country:US
Mailing Address - Phone:818-827-9950
Mailing Address - Fax:818-827-9951
Practice Address - Street 1:11600 INDIAN HILLS RD STE 200B
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1225
Practice Address - Country:US
Practice Address - Phone:818-827-9950
Practice Address - Fax:818-827-9951
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
CAA144020207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program