Basic Information
| Provider Information | |||||||||
| NPI: | 1801214879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIEH | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | YEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 LIND AVS SW | ||||||||
| Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980574970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256902715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1205 N 10TH ST STE 301-C | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256903540 | ||||||||
| FaxNumber: | 4256909540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R3958 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 0 | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | OP61031956 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2158287 | 05 | WA | MEDICAID | 374172001 | 05 | TX | MEDICAID | 374172002 | 01 | TX | CSHCN | OTHER |