MEDICARE: DR. YEN SHIU SHIH DDS

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	122300000X	Dentist	5611	NV
2	122300000X	Dentist	46137	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902085855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YEN SHIU SHIH DDS

Provider Business Mailing Address
First Line	:	324 S DIAMOND BAR BLVD STE 879
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1607
Country	:	US
Telephone Number	:	626-454-0865
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6225
Country	:	US
Telephone Number	:	626-454-0865
Fax Number	:

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

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	03/17/2018

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