Provider Demographics
NPI:1982054896
Name:SHAN, JING (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JING
Middle Name:
Last Name:SHAN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2510
Mailing Address - Country:US
Mailing Address - Phone:415-514-6920
Mailing Address - Fax:415-514-6925
Practice Address - Street 1:490 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2510
Practice Address - Country:US
Practice Address - Phone:415-514-6920
Practice Address - Fax:415-514-6925
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267374207R00000X
CAA150727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine