Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A46449 | CA |
NPI | 1003990227 |
---|---|
Provider Name | Marilyn Shieh |
First Address | Glendale, CA 91226-0321 |
Second Address | San Fernando, CA 91340-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A464490 | (05) | CA |
C39447 | (02) | CA |