Provider Demographics
NPI:1700866969
Name:SHEN, HONG-I (MD)
Entity Type:Individual
Prefix:DR
First Name:HONG-I
Middle Name:
Last Name:SHEN
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 1:3100 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5139
Mailing Address - Country:US
Mailing Address - Phone:903-247-4404
Mailing Address - Fax:903-247-4408
Practice Address - Street 1:3100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5139
Practice Address - Country:US
Practice Address - Phone:903-247-4404
Practice Address - Fax:903-247-4408
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
752946793001OtherTRICARE
TX031401506Medicaid
TX031401505Medicaid
TX031401505Medicaid
TX031401506Medicaid