Healthcare Provider Details

I. General information

NPI: 1790648319
Provider Name (Legal Business Name): CHRISTOPHER SHI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17692 BEACH BLVD STE 209
HUNTINGTON BEACH CA
92647-6810
US

IV. Provider business mailing address

17692 BEACH BLVD STE 209
HUNTINGTON BEACH CA
92647-6810
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-7775
  • Fax:
Mailing address:
  • Phone: 714-842-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER SHI
Title or Position: CEO
Credential: DMD
Phone: 770-845-0727