Provider Demographics
NPI:1063521052
Name:SHIH, STEPHEN LUNGWEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LUNGWEN
Last Name:SHIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:3RD FLOOR PHR SYSTEMS
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:800-823-2020
Mailing Address - Fax:310-257-6610
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:3RD FLOOR PHR SYSTEMS
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:800-823-2020
Practice Address - Fax:310-257-6610
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85822208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053510Medicaid
CA00A858220Medicaid
CAGR0053510Medicaid
CAWA85822AMedicare ID - Type Unspecified
CA00A858220Medicaid