Provider Demographics
NPI:1821158635
Name:SHEH, TIFFANY Y (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:Y
Last Name:SHEH
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15503 VENTURA BLVD STE 350
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3114
Practice Address - Country:US
Practice Address - Phone:818-461-8148
Practice Address - Fax:818-461-8105
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG70118FMedicare ID - Type Unspecified
CAWG70118DMedicare ID - Type Unspecified
CAWG70118GMedicare ID - Type Unspecified
CAWG70118CMedicare ID - Type Unspecified
CAF70470Medicare UPIN
CAWG70118EMedicare ID - Type Unspecified