Provider Demographics
NPI:1407206485
Name:SHUE, HAGENT LAWRENCE (PA)
Entity Type:Individual
Prefix:MR
First Name:HAGENT
Middle Name:LAWRENCE
Last Name:SHUE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19304 AVENIDA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1639
Mailing Address - Country:US
Mailing Address - Phone:310-962-2867
Mailing Address - Fax:
Practice Address - Street 1:19304 AVENIDA DEL SOL
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1639
Practice Address - Country:US
Practice Address - Phone:310-962-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant