Provider Demographics
NPI:1821174210
Name:ALAN SHIENER MD INC.
Entity Type:Organization
Organization Name:ALAN SHIENER MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-5686
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1801
Mailing Address - Country:US
Mailing Address - Phone:818-501-5686
Mailing Address - Fax:818-501-8509
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1827
Practice Address - Country:US
Practice Address - Phone:818-501-5686
Practice Address - Fax:818-501-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30423174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048140Medicaid
CAZZZ946482OtherBLUE SHIELD OF CALIFORNIA
CAZZZ946482OtherBLUE SHIELD OF CALIFORNIA
CAW6380Medicare ID - Type Unspecified