Provider Demographics
NPI:1922150267
Name:LII, SHYH MINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYH MINE
Middle Name:
Last Name:LII
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERMAN
Other - Middle Name:
Other - Last Name:LII
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3859 N. ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770
Mailing Address - Country:US
Mailing Address - Phone:626-572-4044
Mailing Address - Fax:626-572-0962
Practice Address - Street 1:3859 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1976
Practice Address - Country:US
Practice Address - Phone:626-572-4044
Practice Address - Fax:626-572-0962
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48765208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487651Medicaid
CA95-4838332OtherTAX ID
CA95-4378100OtherTAX ID
CAA48765OtherLICENSE NUMBER
CAA48765Medicare ID - Type Unspecified