Provider Demographics
NPI:1578594073
Name:SHIH, CHUAN FANG (MD)
Entity Type:Individual
Prefix:
First Name:CHUAN FANG
Middle Name:
Last Name:SHIH
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 1:1860 MOWRY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1730
Mailing Address - Country:US
Mailing Address - Phone:510-790-2202
Mailing Address - Fax:510-790-2806
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-790-2202
Practice Address - Fax:510-790-2806
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI46796Medicare UPIN
CA00A881790Medicare ID - Type Unspecified