Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 0109542089 | VA |
Y | 208200000X | Surgeon | 0109542089 | VA |
Y | 208600000X | Surgeon | 0109542089 | VA |
NPI | 1790126530 |
---|---|
Provider Name | Yanjun Shi |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 12/12/2014 |