MEDICARE: DR. CHUN-TING SHANG DDS

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	1223P0221X	Pediatric Dentistry	56485	CA

General Provider Information

NPI Number	:	1356545883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUN-TING SHANG DDS

Provider Business Mailing Address
First Line	:	550 DEEP VALLEY DR STE 345
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-377-4551
Fax Number	:	310-541-6042

Provider Business Practice Location Address
First Line	:	550 DEEP VALLEY DR STE 345
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7603
Country	:	US
Telephone Number	:	310-377-4551
Fax Number	:	310-541-6042

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	11/03/2021

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