Provider Demographics
NPI:1407919145
Name:SHEN, KUAN HUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KUAN
Middle Name:HUNG
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST
Mailing Address - Street 2:SUITE 709
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4552
Mailing Address - Country:US
Mailing Address - Phone:212-965-0496
Mailing Address - Fax:212-965-0425
Practice Address - Street 1:139 CENTRE ST
Practice Address - Street 2:SUITE 709
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4552
Practice Address - Country:US
Practice Address - Phone:212-965-0496
Practice Address - Fax:212-965-0425
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY241253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02906994Medicaid
NY1C181EX861Medicare PIN