Provider Demographics
NPI:1225215809
Name:XIANDONG SHI MD
Entity type:Organization
Organization Name:XIANDONG SHI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:XIANDONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-889-6368
Mailing Address - Street 1:13336 41ST RD
Mailing Address - Street 2:UNIT 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3666
Mailing Address - Country:US
Mailing Address - Phone:718-889-6368
Mailing Address - Fax:
Practice Address - Street 1:13336 41ST RD
Practice Address - Street 2:UNIT 2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:718-889-6368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty