Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20A8414 | CA |
N | 111NI0900X | Internist | 20A8414 | CA |
N | 207R00000X | Internist | M0565 | TX |
N | 111NI0900X | Internist | M0565 | TX |
Y | 207U00000X | Nuclear Medicine Specialist | 20A8414 | CA |
N | 207U00000X | Nuclear Medicine Specialist | M0565 | TX |
NPI | 1396765400 |
---|---|
Provider Name | Philip Tsung Han Shie |
First Address | Hacienda Heights, CA 91745-4144 |
Second Address | Fontana, CA 92335-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 29/11/2021 |