Provider Demographics
NPI:1689174039
Name:SHIH, JOHN MICHAEL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:SHIH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 GOLF RIDGE CT APT 302
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2623
Mailing Address - Country:US
Mailing Address - Phone:202-818-9198
Mailing Address - Fax:
Practice Address - Street 1:9600 BLACKWELL RD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3850
Practice Address - Country:US
Practice Address - Phone:240-403-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist