1275529984 NPI number — DR. KAN C SHIEH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275529984 NPI number — DR. KAN C SHIEH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHIEH

Provider First Name:

KAN

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1275529984

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/17/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

421 W CHEW ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ALLENTOWN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18102-3406

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-663-3441

Provider Business Mailing Address Fax Number:

610-663-3170

Provider First Line Business Practice Location Address:

421 W CHEW ST

Provider Second Line Business Practice Location Address:

DEPARTMENT OF DIAGNOSTIC RADIOLOGY

Provider Business Practice Location Address City Name:

ALLENTOWN

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18102-3406

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-776-4822

Provider Business Practice Location Address Fax Number:

610-776-4671

Provider Enumeration Date:

09/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  MD018723E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01383002 . This is a "CBC NIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 1090091 . This is a "AMERIHEALTH MERCY CREST" identifier . This identifiers is of the category "OTHER".
• Identifier: 1117594 . This is a "AMERIHEALTH MERCY NIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 300049626 . This is a "RR MEDICARE NIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 0040588000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
• Identifier: 0006738600009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 01383001 . This is a "CBC CREST" identifier . This identifiers is of the category "OTHER".
• Identifier: 110260 . This is a "UNISON CREST" identifier . This identifiers is of the category "OTHER".
• Identifier: 0006738600007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 003448 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 125479 . This is a "UNISON NIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 300041670 . This is a "RR MEDICARE CREST" identifier . This identifiers is of the category "OTHER".