Provider Demographics
NPI:1912044256
Name:SHAN KAUR M.D.
Entity Type:Organization
Organization Name:SHAN KAUR M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-897-4741
Mailing Address - Street 1:165 ROWLAND WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5038
Mailing Address - Country:US
Mailing Address - Phone:415-897-4741
Mailing Address - Fax:415-897-2971
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-897-4741
Practice Address - Fax:415-897-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A411880Medicare ID - Type Unspecified
A29327Medicare UPIN