Provider Demographics
NPI:1851481758
Name:SHEN, ALBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:C
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 1:316 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1605
Mailing Address - Country:US
Mailing Address - Phone:408-296-9800
Mailing Address - Fax:408-296-9805
Practice Address - Street 1:316 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1605
Practice Address - Country:US
Practice Address - Phone:408-296-9800
Practice Address - Fax:408-296-9805
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75131208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23414ZMedicare ID - Type Unspecified
CAG75131Medicare UPIN