Provider Demographics
NPI:1609861822
Name:SHEN, EDWARD N (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:N
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:STE 701
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-587-8200
Mailing Address - Fax:808-531-8201
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:STE 701
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-587-8200
Practice Address - Fax:808-531-8201
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD5430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02052501Medicaid
A46365Medicare UPIN
HI02052501Medicaid