Provider Demographics
NPI:1205871233
Name:KAO, SHIH YIN ANNA (MD)
Entity type:Individual
Prefix:
First Name:SHIH YIN
Middle Name:ANNA
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIH YIN
Other - Middle Name:ANNA
Other - Last Name:KAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CLARK-HOLDER CLINIC, P.A.
Mailing Address - Street 2:303 SMITH STREET
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-882-8831
Mailing Address - Fax:706-812-4091
Practice Address - Street 1:CLARK-HOLDER CLINIC, P.A.
Practice Address - Street 2:303 SMITH STREET
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-882-8831
Practice Address - Fax:706-812-4091
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48788207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932400Medicaid
GA000876158AMedicaid
H17073Medicare UPIN
GA000876158AMedicaid