Provider Demographics
NPI:1275529984
Name:SHIEH, KAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAN
Middle Name:C
Last Name:SHIEH
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 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-663-3441
Mailing Address - Fax:610-663-3170
Practice Address - Street 1:421 W CHEW ST
Practice Address - Street 2:DEPARTMENT OF DIAGNOSTIC RADIOLOGY
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3406
Practice Address - Country:US
Practice Address - Phone:610-776-4822
Practice Address - Fax:610-776-4671
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018723E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01383002OtherCBC NIC
1090091OtherAMERIHEALTH MERCY CREST
1117594OtherAMERIHEALTH MERCY NIC
300049626OtherRR MEDICARE NIC
0040588000OtherIBC
PA0006738600009Medicaid
01383001OtherCBC CREST
110260OtherUNISON CREST
PA0006738600007Medicaid
003448OtherHIGHMARK BLUE SHIELD
125479OtherUNISON NIC
300041670OtherRR MEDICARE CREST
110260OtherUNISON CREST
300041670OtherRR MEDICARE CREST
003448OtherHIGHMARK BLUE SHIELD