Provider Demographics
NPI:1609069590
Name:SHYUN JENG M.D. INC
Entity Type:Organization
Organization Name:SHYUN JENG M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-792-9229
Mailing Address - Street 1:21350 HAWTHORNE BLVD STE 168
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5612
Mailing Address - Country:US
Mailing Address - Phone:310-792-9229
Mailing Address - Fax:310-316-7117
Practice Address - Street 1:21350 HAWTHORNE BLVD STE 168
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5612
Practice Address - Country:US
Practice Address - Phone:310-792-9229
Practice Address - Fax:310-316-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053363207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31146OtherMEDICARE NHIC