Healthcare Provider Details

I. General information

NPI: 1295726008
Provider Name (Legal Business Name): LUCY SHIH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 04/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD SUITE 105
ARCADIA CA
91007-7606
US

IV. Provider business mailing address

622 W DUARTE RD SUITE 105
ARCADIA CA
91007-7606
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-6921
  • Fax: 626-574-9604
Mailing address:
  • Phone: 626-574-6921
  • Fax: 626-574-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG52831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: