Provider Demographics
NPI:1669554887
Name:KER, SHIUN T (MD)
Entity type:Individual
Prefix:
First Name:SHIUN
Middle Name:T
Last Name:KER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:S
Other - Last Name:KER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:ROOM 306
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-571-8271
Mailing Address - Fax:626-571-8106
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:ROOM 306
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-571-8271
Practice Address - Fax:626-571-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43001208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6244319Medicaid
CA6244319Medicaid