Jiayu Shi, DDS, PHD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE61133313 Issued in WA

Practice address

12305 120TH Ave NE Ste G
Kirkland, WA 98034-6921

Phone

(425) 588-3899

Fax

(425) 588-3898

NPI assigned

Dec 16, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shi & Pan, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Kirkland, WA
  • NPI 1548043284
  NPD Authorized official
• Willamette Dental Group, P.C.

  • Dentist
  • Seattle, WA
  • NPI 1033034491
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1336735117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12305 120TH AVE NE STE G",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346921",
            "telephone_number": "425-588-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12305 120TH AVE NE STE G",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346921",
            "telephone_number": "425-588-3899",
            "fax_number": "425-588-3898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHI",
        "first_name": "JIAYU",
        "credential": "DDS, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-16",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE61133313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Shepard
• Dana Shephard
• Kristen Brewer Sherman
• Tonia Sherman, LMP
• Shi & Pan, PLLC
• Katherine Sarah Shieff
• Ashley Shields
• Elizabeth Shields, M.A.
• Pam R Shigaya, RPH
• Victor Bing-Sheng Shih, DDS

• Orthodontics and Dentofacial Orthopedics Dentistry in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.