Provider Demographics
NPI:1396195475
Name:GUAN, SHENGSHENG (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHENGSHENG
Middle Name:
Last Name:GUAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 ALMADEN EXPY STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1253
Mailing Address - Country:US
Mailing Address - Phone:650-762-9855
Mailing Address - Fax:
Practice Address - Street 1:3150 ALMADEN EXPY STE 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1253
Practice Address - Country:US
Practice Address - Phone:650-762-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5590213ES0103X
MD9764213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery