Provider Demographics
NPI:1174921266
Name:CHIA, SHIMA (PA-C)
Entity type:Individual
Prefix:
First Name:SHIMA
Middle Name:
Last Name:CHIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHI
Other - Middle Name:MA
Other - Last Name:CHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 E DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2858
Mailing Address - Country:US
Mailing Address - Phone:708-733-7750
Mailing Address - Fax:708-745-3380
Practice Address - Street 1:770 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2858
Practice Address - Country:US
Practice Address - Phone:708-733-7750
Practice Address - Fax:708-745-3380
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant