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General NPI Number Information
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NPI Number | 1841796646
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Entity Type | Individual
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Provider Name | JOHNATHAN SHIH MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 3801 HOWE ST
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City | OAKLAND
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State | CA
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Zip | 94611-5312
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Country | US
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Telephone | 510-616-8472
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Fax |
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Provider Business Mailing Address
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Address Line | 649 VIA RIALTO
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City | OAKLAND
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State | CA
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Zip | 94619-3149
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Country | US
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Telephone | 661-364-3597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A196431
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License Number State | CA
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