Provider Demographics
NPI:1194093971
Name:SHI, ANNA JING (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:JING
Last Name:SHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 UPPER RAGSDALE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7858
Mailing Address - Country:US
Mailing Address - Phone:831-372-1500
Mailing Address - Fax:
Practice Address - Street 1:21 UPPER RAGSDALE DR STE 200
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7858
Practice Address - Country:US
Practice Address - Phone:831-372-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205654207W00000X
CAA156796207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02124040Medicaid
LA2199722Medicaid
MS02124040Medicaid
LA2199722Medicaid