Healthcare Provider Details

I. General information

NPI: 1164348496
Provider Name (Legal Business Name): JEREMY SHIH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
WEST READING PA
19611-2143
US

IV. Provider business mailing address

1375 PERSHING BLVD APT 601
READING PA
19607-1461
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007675
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: