Provider Demographics
NPI:1629671193
Name:SHAH, JENNY SOO-JIN (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:SOO-JIN
Last Name:SHAH
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 1:8245 COLONIAL WOODS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4941
Mailing Address - Country:US
Mailing Address - Phone:956-909-0124
Mailing Address - Fax:
Practice Address - Street 1:11311 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6812
Practice Address - Country:US
Practice Address - Phone:210-682-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist