Healthcare Provider Details

I. General information

NPI: 1861663791
Provider Name (Legal Business Name): THOMAS SHIEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 CHALAN SAN ANTONIO SUITE 108
TAMUNING GU
96913
US

IV. Provider business mailing address

643 CHALAN SAN ANTONIO SUITE 108
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-648-2229
  • Fax: 671-648-2220
Mailing address:
  • Phone: 671-648-2229
  • Fax: 671-648-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM-1181
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: