Provider Demographics
NPI:1336735117
Name:SHI, JIAYU (DDS, PHD)
Entity Type:Individual
Prefix:
First Name:JIAYU
Middle Name:
Last Name:SHI
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 120TH AVE NE STE G
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6921
Mailing Address - Country:US
Mailing Address - Phone:425-588-3899
Mailing Address - Fax:
Practice Address - Street 1:12305 120TH AVE NE STE G
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6921
Practice Address - Country:US
Practice Address - Phone:425-588-3899
Practice Address - Fax:425-588-3898
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611333131223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics