Provider Demographics
NPI:1891282547
Name:SHAO, KIMBERLY RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RACHEL
Last Name:SHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:235 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5003
Mailing Address - Country:US
Mailing Address - Phone:516-581-5189
Mailing Address - Fax:
Practice Address - Street 1:3025 GOVERNORS PLACE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1330
Practice Address - Country:US
Practice Address - Phone:937-293-5567
Practice Address - Fax:937-293-5568
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.144767207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery