Healthcare Provider Details

I. General information

NPI: 1518344910
Provider Name (Legal Business Name): CDC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 E INDIAN SCHOOL RD STE 3
SCOTTSDALE AZ
85251-4043
US

IV. Provider business mailing address

7700 E INDIAN SCHOOL RD STE 3
SCOTTSDALE AZ
85251-4043
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-7070
  • Fax: 480-941-0067
Mailing address:
  • Phone: 480-941-7070
  • Fax: 480-941-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7163
License Number StateAZ

VIII. Authorized Official

Name: DR. ROY SHIM
Title or Position: CEO
Credential: DDS
Phone: 480-941-7070