Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 25MA02834800 | NJ |
NPI | 1053411272 |
---|---|
Provider Name | Jung San Shen |
First Address | Elizabeth, NJ 07202-3453 |
Second Address | Elizabeth, NJ 07202-3453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2112701 | (05) | NJ |
C57906 | (02) | NJ |