Healthcare Provider Details

I. General information

NPI: 1912343831
Provider Name (Legal Business Name): DONG SHEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOUTH DR SUITE 140
MOUNTAIN VIEW CA
94040-4311
US

IV. Provider business mailing address

105 SOUTH DR SUITE 140
MOUNTAIN VIEW CA
94040-4311
US

V. Phone/Fax

Practice location:
  • Phone: 650-938-1868
  • Fax: 650-938-1968
Mailing address:
  • Phone: 650-938-1868
  • Fax: 650-938-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DONG SHEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 650-938-1868