Provider Demographics
NPI:1760800502
Name:SHAO KASHMANIAN, JENNY MENG (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MENG
Last Name:SHAO KASHMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:SHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2926A TAUBMAN CENTER
Mailing Address - Street 2:1500 E. MEDICAL CENTER DRIVE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:260-416-2390
Mailing Address - Fax:
Practice Address - Street 1:2926A TAUBMAN CENTER
Practice Address - Street 2:1500 E. MEDICAL CENTER DRIVE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5331
Practice Address - Country:US
Practice Address - Phone:734-936-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508343208600000X
NJ25MA10910800208600000X
PAMD470977208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery