Provider Demographics
NPI:1295399756
Name:SHI, KATHERINE JIE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JIE
Last Name:SHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2709
Mailing Address - Country:US
Mailing Address - Phone:678-507-4824
Mailing Address - Fax:
Practice Address - Street 1:1810 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2165
Practice Address - Country:US
Practice Address - Phone:916-485-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics