Provider Demographics
NPI:1669630521
Name:SHI, RONG (MD)
Entity Type:Individual
Prefix:DR
First Name:RONG
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5616
Mailing Address - Country:US
Mailing Address - Phone:619-297-3737
Mailing Address - Fax:619-297-0443
Practice Address - Street 1:3260 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5616
Practice Address - Country:US
Practice Address - Phone:619-297-3737
Practice Address - Fax:619-297-0443
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine