Provider Demographics
NPI:1609178136
Name:ABE, SHOKO EMILY (MD)
Entity Type:Individual
Prefix:
First Name:SHOKO
Middle Name:EMILY
Last Name:ABE
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 1:3100 SAN PABLO AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2498
Mailing Address - Country:US
Mailing Address - Phone:415-476-3358
Mailing Address - Fax:510-985-5202
Practice Address - Street 1:3100 SAN PABLO AVE STE 430
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2498
Practice Address - Country:US
Practice Address - Phone:415-476-3358
Practice Address - Fax:510-985-5202
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00996208600000X
PAMT188328208600000X
NE26133208C00000X
CAA132984208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609178136Medicaid
IA1609178136Medicaid
NE47053395014Medicaid
NC1609178136Medicaid
NCNCC988AMedicare PIN
CACA135091Medicare UPIN
NE47053395014Medicaid