Provider Demographics
NPI:1164655411
Name:SHI, FONG-WEN SHI (MD)
Entity Type:Individual
Prefix:DR
First Name:FONG-WEN SHI
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SEC 1, CHUNG-CHENG ROAD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TAIPEI
Mailing Address - State:TAIWAN
Mailing Address - Zip Code:111
Mailing Address - Country:TW
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 SEC 1, CHUNG-CHENG ROAD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TAIPEI
Practice Address - State:TAIWAN
Practice Address - Zip Code:111
Practice Address - Country:TW
Practice Address - Phone:022-831-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47254146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic