MEDICARE: KYLE SHIH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811336720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SHIH D.O.

Provider Business Mailing Address
First Line	:	100 HOSPITAL RD STE 201
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HOSPITAL RD STE 201
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-8814
Country	:	US
Telephone Number	:	631-447-3010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	12/22/2021

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