Healthcare Provider Details

I. General information

NPI: 1194001503
Provider Name (Legal Business Name): YAN SHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

1 BAYLOR PLZ SUITE 404D
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 168-443-0152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number35.140369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: