Provider Demographics
NPI:1063648863
Name:SHI, MINHUAI (DDS)
Entity type:Individual
Prefix:MR
First Name:MINHUAI
Middle Name:
Last Name:SHI
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 1:6708 152ND ST
Mailing Address - Street 2:SUITE 266A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1430
Mailing Address - Country:US
Mailing Address - Phone:347-205-0616
Mailing Address - Fax:
Practice Address - Street 1:816 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3783
Practice Address - Country:US
Practice Address - Phone:347-205-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0562381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program