Healthcare Provider Details

I. General information

NPI: 1801893920
Provider Name (Legal Business Name): PAUL P. SHINTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE SUITE 205
PASADENA CA
91105-2536
US

IV. Provider business mailing address

301 S FAIR OAKS AVE SUITE 205
PASADENA CA
91105-2536
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-8904
  • Fax: 323-681-2192
Mailing address:
  • Phone: 626-796-8904
  • Fax: 323-681-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: