MEDICARE: DR. SIMON SHUNG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS036205	PA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	60240	CA

General Provider Information

NPI Number	:	1134104052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON SHUNG DMD

Provider Business Mailing Address
First Line	:	54 TWIN GABLES
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3507
Country	:	US
Telephone Number	:	412-736-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	6246 IRVINE BLVD
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2103
Country	:	US
Telephone Number	:	949-264-3314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	02/28/2015

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