Provider Demographics
NPI:1437807526
Name:XIE, SHANG
Entity Type:Individual
Prefix:
First Name:SHANG
Middle Name:
Last Name:XIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 EASTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4515
Mailing Address - Country:US
Mailing Address - Phone:562-381-0048
Mailing Address - Fax:
Practice Address - Street 1:7625 EASTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4515
Practice Address - Country:US
Practice Address - Phone:562-381-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist