Provider Demographics
NPI:1265727127
Name:SHIEH, MARIE HONG (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:HONG
Last Name:SHIEH
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 1:2501 NAVARRA DR
Mailing Address - Street 2:UNIT 124
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7002
Mailing Address - Country:US
Mailing Address - Phone:760-635-7838
Mailing Address - Fax:
Practice Address - Street 1:2501 NAVARRA DR
Practice Address - Street 2:UNIT 124
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7002
Practice Address - Country:US
Practice Address - Phone:760-635-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602610Medicaid
CAWA60261AMedicare PIN
CA00A602610Medicaid