Provider Demographics
NPI:1205019882
Name:SHI, KEVIN CHAOCHI II
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHAOCHI
Last Name:SHI
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5431
Mailing Address - Country:US
Mailing Address - Phone:718-886-3212
Mailing Address - Fax:718-886-9195
Practice Address - Street 1:3915 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5431
Practice Address - Country:US
Practice Address - Phone:718-886-3212
Practice Address - Fax:718-886-9195
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist