Provider Demographics
NPI:1629004478
Name:SHIU, MARK L (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:SHIU
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Gender:M
Credentials:DO
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Mailing Address - Street 1:7974 HAVEN AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3052
Mailing Address - Country:US
Mailing Address - Phone:800-734-1733
Mailing Address - Fax:800-734-1733
Practice Address - Street 1:7974 HAVEN AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3052
Practice Address - Country:US
Practice Address - Phone:800-734-1733
Practice Address - Fax:800-734-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-07-25
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Provider Licenses
StateLicense IDTaxonomies
CA20A9372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX93720Medicaid
CA020A93720Medicare ID - Type UnspecifiedMEDICARE
CAI49929Medicare UPIN