Provider Demographics
NPI:1639138118
Name:SHENKIN, BUDD NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:BUDD
Middle Name:NORMAN
Last Name:SHENKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 DUBLIN BLVD
Mailing Address - Street 2:SUITE C 140
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-587-2505
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-452-5231
Practice Address - Fax:510-869-6679
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G184250OtherMEDICARE PTAN
00G184255OtherMEDICARE - PTAN
CAF50977Medicare UPIN
00G184255Medicare PIN
00G184250OtherMEDICARE PTAN