=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558619197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNIE SHIH, DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2012
-----------------------------------------------------
Last Update Date | 08/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2237 PARK TOWNE CIR STE 1
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95825-0417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-698-3518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5428 NECTAR CIR
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95757-4335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANNIE SHIH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-698-3518
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 51423
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------