Healthcare Provider Details

I. General information

NPI: 1063709020
Provider Name (Legal Business Name): ANGELL C SHIEH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE SUITE 106
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7300 GIRARD AVE SUITE 106
LA JOLLA CA
92037-5138
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-4351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: