Provider Demographics
NPI:1518058742
Name:SHU, ANNIE TS (MD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:TS
Last Name:SHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 W DUARTE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7610
Mailing Address - Country:US
Mailing Address - Phone:626-445-1278
Mailing Address - Fax:626-445-1784
Practice Address - Street 1:632 W DUARTE RD STE 170
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7610
Practice Address - Country:US
Practice Address - Phone:626-445-1278
Practice Address - Fax:626-445-1784
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536840Medicaid
CAG44196Medicare UPIN
CAWA 53684AMedicare ID - Type Unspecified
CA00A536840Medicaid