Provider Demographics
NPI:1194960013
Name:SHIEH, EUGENIE
Entity type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:SHIEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUGENIE
Other - Middle Name:
Other - Last Name:SHIEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2331 MONTPELIER DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-0020
Mailing Address - Country:US
Mailing Address - Phone:408-515-2428
Mailing Address - Fax:
Practice Address - Street 1:2331 MONTPELIER DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-347-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148682207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program