Provider Demographics
NPI:1770585515
Name:SHIENER, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:SHIENER
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 1:18167 CHARDON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-342-9973
Mailing Address - Fax:818-342-9976
Practice Address - Street 1:18167 CHARDON CIRCLE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-342-9973
Practice Address - Fax:818-342-9976
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30423207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060047086OtherRAILROAD MEDICARE
CA95354702891403B003OtherTRICARE WEST REGION
CAZZZ94648ZOtherBLUE SHIELD
CA00G304230Medicaid
CAZZZ94648ZOtherBLUE SHIELD
CA00G304230Medicaid
CAA44419Medicare UPIN