Healthcare Provider Details

I. General information

NPI: 1770010563
Provider Name (Legal Business Name): TIANTIAN SHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 TALON DR STE 100
RICHARDSON TX
75082-9720
US

IV. Provider business mailing address

3200 TALON DR STE 100
RICHARDSON TX
75082-9720
US

V. Phone/Fax

Practice location:
  • Phone: 214-431-4539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU6580
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU6580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: