MEDICARE: DR. TYSON SHIH MD

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	207Y00000X	Otolaryngology Physician	A38665	CA

General Provider Information

NPI Number	:	1932181138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYSON SHIH MD

Provider Business Mailing Address
First Line	:	151 W WILLOW ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1829
Country	:	US
Telephone Number	:	909-469-1888
Fax Number	:	909-469-1888

Provider Business Practice Location Address
First Line	:	151 W WILLOW ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1829
Country	:	US
Telephone Number	:	909-469-1888
Fax Number	:	909-469-1888

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	12/01/2021

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