Provider Demographics
NPI:1477530236
Name:SHIH, YONG L (DO)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:L
Last Name:SHIH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E NORTH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4960
Mailing Address - Country:US
Mailing Address - Phone:209-239-8086
Mailing Address - Fax:866-589-7497
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:209-239-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX88650Medicaid
CA20A8865OtherLICENSE NUMBER
CAI15714Medicare UPIN
CA020A88650Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER