Individual
SHANSHAN MOU BOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1321 COLBY AVE, EVERETT, WA 98201-1665
(425) 261-2000
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD60352938
WA
208M00000X
Hospitalist Physician
MD60352938
WA
390200000X
Student in an Organized Health Care Education/Training Program
A118118
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/09/2010
Last updated
03/29/2021
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