Provider Demographics
NPI:1104408632
Name:SHIAH, KEVIN P (DO, MS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:SHIAH
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-5908
Mailing Address - Fax:951-486-5910
Practice Address - Street 1:26520 CACTUS AVE CPC STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-5908
Practice Address - Fax:951-486-5910
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A21971208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty