Healthcare Provider Details

I. General information

NPI: 1396613451
Provider Name (Legal Business Name): CHIN-HUSN SHIH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 S RIDGELAND AVE STE E
PALOS HEIGHTS IL
60463-2391
US

IV. Provider business mailing address

12800 S RIDGELAND AVE
PALOS HEIGHTS IL
60463-2390
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-3700
  • Fax:
Mailing address:
  • Phone: 708-429-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025065257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: