Provider Demographics
NPI:1366646283
Name:SHEN, HONGGANG (MD)
Entity Type:Individual
Prefix:DR
First Name:HONGGANG
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 1:19952 E SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5330
Mailing Address - Country:US
Mailing Address - Phone:909-374-6801
Mailing Address - Fax:
Practice Address - Street 1:2440 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 181
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1784
Practice Address - Country:US
Practice Address - Phone:310-689-1815
Practice Address - Fax:310-689-1818
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73185207ZD0900X
NV15811207ZD0900X
AZ35355207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology