Healthcare Provider Details

I. General information

NPI: 1356545883
Provider Name (Legal Business Name): CHUN-TING SHANG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 DEEP VALLEY DR STE 345
ROLLING HILLS ESTATES CA
90274-7603
US

IV. Provider business mailing address

550 DEEP VALLEY DR STE 345
ROLLING HILLS ESTATES CA
90274-7603
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-4551
  • Fax: 310-541-6042
Mailing address:
  • Phone: 310-377-4551
  • Fax: 310-541-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number56485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: