Provider Demographics
NPI:1578681722
Name:SHAW, STEPHEN SHOUTIEN (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SHOUTIEN
Last Name:SHAW
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROSS ALY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1203
Mailing Address - Country:US
Mailing Address - Phone:415-397-1798
Mailing Address - Fax:
Practice Address - Street 1:17 ROSS ALY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1203
Practice Address - Country:US
Practice Address - Phone:415-397-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0025650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist