Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 9317 | NV |
NPI | 1013995737 |
---|---|
Provider Name | Dr. Gary K Shen |
First Address | Los Angeles, CA 90051-0598 |
Second Address | Las Vegas, NV 89102-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 26/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013995737 | (05) | NV |
BS2203367 | DEA (01) | NV |
CS09763 | PHARMACY/CDS (01) | NV |
G31682 | (02) | NV |
V52007 | PTAN (01) | NV |