Provider Demographics
NPI:1912138470
Name:SHI, YANYAN EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:YANYAN
Middle Name:EILEEN
Last Name:SHI
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:5575 S DURANGO DR
Practice Address - Street 2:#103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1833
Practice Address - Country:US
Practice Address - Phone:702-435-5473
Practice Address - Fax:702-851-9640
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics