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Individual

STANFORD SHU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11370 ANDERSON ST, STE B-100, LOMA LINDA, CA 92354-3450
(909) 558-2848
Mailing address
54701 FILE NUMBER, LOS ANGELES, CA 90074-4701
(909) 558-3111

Taxonomy

Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
G79503
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G795030
CA
Enumeration date
07/21/2006
Last updated
06/23/2010
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