Healthcare Provider Details

I. General information

NPI: 1992884910
Provider Name (Legal Business Name): YAMING SHI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax: 562-809-1310
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA81918
License Number StateCA

VIII. Authorized Official

Name: DEBORAH SIGMAN
Title or Position: MANAGER
Credential:
Phone: 949-588-2190