Provider Demographics
NPI:1447469432
Name:SHEN, HUILAN JEN
Entity type:Individual
Prefix:
First Name:HUILAN
Middle Name:JEN
Last Name:SHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 97TH ST # 3FL
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3032
Mailing Address - Country:US
Mailing Address - Phone:718-592-1941
Mailing Address - Fax:
Practice Address - Street 1:2367 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5007
Practice Address - Country:US
Practice Address - Phone:718-597-2900
Practice Address - Fax:718-597-2902
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist