Provider Demographics
NPI:1548043284
Name:SHI & PAN, PLLC
Entity type:Organization
Organization Name:SHI & PAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JIAYU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:310-845-5276
Mailing Address - Street 1:1321 5TH LN
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5667
Mailing Address - Country:US
Mailing Address - Phone:310-845-5276
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty