Provider Demographics
NPI:1649496498
Name:SHIH, SAN CHENG (MD)
Entity type:Individual
Prefix:
First Name:SAN
Middle Name:CHENG
Last Name:SHIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13605 SANFORD AVE
Mailing Address - Street 2:1M
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3136
Mailing Address - Country:US
Mailing Address - Phone:718-321-3996
Mailing Address - Fax:718-321-0071
Practice Address - Street 1:13605 SANFORD AVE
Practice Address - Street 2:1M
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3136
Practice Address - Country:US
Practice Address - Phone:718-321-3996
Practice Address - Fax:718-321-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1959182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557648Medicaid