Provider Demographics
NPI:1497927834
Name:REID, SHAUN RYAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:RYAN
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5977 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3752
Mailing Address - Country:US
Mailing Address - Phone:562-421-3727
Mailing Address - Fax:562-420-8948
Practice Address - Street 1:5977 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3752
Practice Address - Country:US
Practice Address - Phone:562-421-3727
Practice Address - Fax:562-420-8948
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA98398OtherCALIFORNIA STATE LICENSE