Basic Information
Provider Information
NPI: 1144516972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHEIN
FirstName: THWE
MiddleName: THWE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 COFFEE RD
Address2:  
City: MODESTO
State: CA
PostalCode: 953554201
CountryCode: US
TelephoneNumber: 2095216097
FaxNumber:  
Practice Location
Address1: 2505 W HAMMER LN
Address2:  
City: STOCKTON
State: CA
PostalCode: 952092839
CountryCode: US
TelephoneNumber: 2099577050
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2011
LastUpdateDate: 09/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA127899CAY Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XA127899CAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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