Provider Demographics
NPI:1881988541
Name:SHEN, JOHNNY (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:SHEN
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 1:2003 BIRNAM GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6421
Mailing Address - Country:US
Mailing Address - Phone:267-231-9016
Mailing Address - Fax:
Practice Address - Street 1:760 S COLORADO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1954
Practice Address - Country:US
Practice Address - Phone:303-692-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040640207Q00000X
CODR0054115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine