Provider Demographics
NPI:1902085855
Name:SHIH, YEN SHIU (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:SHIU
Last Name:SHIH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S DIAMOND BAR BLVD STE 879
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1607
Mailing Address - Country:US
Mailing Address - Phone:626-454-0865
Mailing Address - Fax:
Practice Address - Street 1:2413 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6225
Practice Address - Country:US
Practice Address - Phone:626-454-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5611122300000X
CA46137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902085855Medicaid