Provider Demographics
NPI:1356647788
Name:SHU, RICHARD GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GERALD
Last Name:SHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25405 HANCOCK AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5978
Mailing Address - Country:US
Mailing Address - Phone:951-698-4600
Mailing Address - Fax:951-514-2542
Practice Address - Street 1:25405 HANCOCK AVE STE 216
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5978
Practice Address - Country:US
Practice Address - Phone:951-698-4600
Practice Address - Fax:951-514-2542
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA115553207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18762OtherGROUP MEDICARE
CA1902846306OtherGROUP NPI
CAGR0100430OtherGROUP MEDI-CAL