Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35.140369 | OH |
NPI | 1194001503 |
---|---|
Provider Name | Yan Shi |
First Address | Houston, TX 77030-3411 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2011 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35.140369 | OHIO MEDICAL BOARD (01) | OH |
557792 | TEXAS MEDICAL BOARD PHYSICIAN IN TRAINING (01) | TX |
BP10039781 | TEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT (01) | TX |