Healthcare Provider Details

I. General information

NPI: 1902006836
Provider Name (Legal Business Name): ANDREW BEIHONG SHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22421 EL TORO RD SUITE E
LAKE FOREST CA
92630-5049
US

IV. Provider business mailing address

2 CARTIER AISLE
IRVINE CA
92620-5708
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-4707
  • Fax: 949-770-4708
Mailing address:
  • Phone: 415-503-7584
  • Fax: 949-770-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: