1275561284 NPI number — YAMING SHI MD

Table of content: YAMING SHI MD (NPI 1275561284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275561284 NPI number — YAMING SHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHI
Provider First Name:
YAMING
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1275561284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14120 ALONDRA BLVD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90670-5842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-407-2080
Provider Business Mailing Address Fax Number:
562-407-2082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21530 PIONEER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWAIIAN GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90716-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-407-2080
Provider Business Practice Location Address Fax Number:
562-407-2082
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  A81918 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A81918 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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