Provider Demographics
NPI:1063947653
Name:SHIAO, JAY C (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:SHIAO
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 1:4001 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8504
Mailing Address - Country:US
Mailing Address - Phone:469-463-0307
Mailing Address - Fax:
Practice Address - Street 1:4001 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8504
Practice Address - Country:US
Practice Address - Phone:469-463-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665483207R00000X
MO20220410172085R0001X
COTL.00074502085R0001X
KS04-468232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine