Provider Demographics
NPI:1538127899
Name:SHIUE, SHYI-TANG (MD)
Entity Type:Individual
Prefix:
First Name:SHYI-TANG
Middle Name:
Last Name:SHIUE
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 1:11108 ZENAIDA WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-2928
Mailing Address - Country:US
Mailing Address - Phone:661-325-2640
Mailing Address - Fax:661-327-0816
Practice Address - Street 1:1700 C ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3616
Practice Address - Country:US
Practice Address - Phone:661-325-2640
Practice Address - Fax:661-327-0816
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049658207RA0000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA049658Medicaid
CA00A496580Medicare ID - Type Unspecified
CAA049658Medicaid