Provider Demographics
NPI:1841299963
Name:CHEN, SHAWN (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:XIONG
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC ACUPUNCTURIST
Mailing Address - Street 1:2197 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1855
Mailing Address - Country:US
Mailing Address - Phone:415-566-0273
Mailing Address - Fax:415-753-2504
Practice Address - Street 1:2197 17TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1855
Practice Address - Country:US
Practice Address - Phone:415-566-0273
Practice Address - Fax:415-753-2504
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0037630OtherMEDI-CAL