Provider Demographics
NPI:1366578544
Name:SHAW, YASMEEN (MD)
Entity type:Individual
Prefix:DR
First Name:YASMEEN
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:SUITE #3400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3564
Mailing Address - Fax:916-734-7924
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE #3400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3564
Practice Address - Fax:916-734-7924
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41962207R00000X
CAA108908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100043390Medicaid
KY1366612Medicare PIN