Healthcare Provider Details

I. General information

NPI: 1376391540
Provider Name (Legal Business Name): EMILY SHUM AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

9033 BASE LINE RD STE A
RANCHO CUCAMONGA CA
91730-1214
US

IV. Provider business mailing address

9033 BASE LINE RD STE A
RANCHO CUCAMONGA CA
91730-1214
US

V. Phone/Fax

Practice location:
  • Phone: 909-293-9124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY WEAR SHUM
Title or Position: OWNER
Credential: PH.D.
Phone: 909-239-9124