Provider Demographics
NPI:1790888204
Name:SHEN, SHARON YUYEN
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:YUYEN
Last Name:SHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 GARVEY AVE.
Mailing Address - Street 2:#103
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3931
Mailing Address - Country:US
Mailing Address - Phone:626-573-1755
Mailing Address - Fax:626-573-2178
Practice Address - Street 1:8150 GARVEY AVE
Practice Address - Street 2:#103
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2472
Practice Address - Country:US
Practice Address - Phone:626-573-1755
Practice Address - Fax:626-573-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5479156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX005763FMedicaid