Healthcare Provider Details

I. General information

NPI: 1760229157
Provider Name (Legal Business Name): MICHAEL ANDREW SHUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 HAMNER AVE STE C
NORCO CA
92860-3136
US

IV. Provider business mailing address

17365 RIDGEDALE LN
YORBA LINDA CA
92886-1847
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-4766
  • Fax:
Mailing address:
  • Phone: 714-386-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: