Provider Demographics
NPI:1447322581
Name:SHIH, I-JAI (OD)
Entity type:Individual
Prefix:DR
First Name:I-JAI
Middle Name:
Last Name:SHIH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 SIERRA LEONE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5837
Mailing Address - Country:US
Mailing Address - Phone:626-913-7088
Mailing Address - Fax:
Practice Address - Street 1:1758 SIERRA LEONE AVE STE A
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-5837
Practice Address - Country:US
Practice Address - Phone:626-913-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10590T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105901Medicaid
CAU73411Medicare UPIN
CAOP 10590Medicare ID - Type Unspecified