Healthcare Provider Details

I. General information

NPI: 1750447264
Provider Name (Legal Business Name): JENNIFER SHIH M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 ROSEMEAD BLVD STE A
ROSEMEAD CA
91770-4400
US

IV. Provider business mailing address

4124 N.ROSEMEAD BLVD. #A
ROSEMEAD CA
91770
US

V. Phone/Fax

Practice location:
  • Phone: 626-285-2477
  • Fax:
Mailing address:
  • Phone: 626-285-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: