Provider Demographics
NPI:1821361494
Name:SHON, CHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAN
Middle Name:S
Last Name:SHON
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 1:4460 WILSHIRE BLVD
Mailing Address - Street 2:#703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3722
Mailing Address - Country:US
Mailing Address - Phone:661-312-1478
Mailing Address - Fax:
Practice Address - Street 1:4460 WILSHIRE BLVD
Practice Address - Street 2:#703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3722
Practice Address - Country:US
Practice Address - Phone:661-312-1478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC504732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC01914Medicare UPIN