Healthcare Provider Details

I. General information

NPI: 1568829562
Provider Name (Legal Business Name): DAVID SHEN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FREMONT AVE STE J2
SUNNYVALE CA
94087-2332
US

IV. Provider business mailing address

883 SNEATH LN #130
SAN BRUNO CA
94066-2409
US

V. Phone/Fax

Practice location:
  • Phone: 408-738-8400
  • Fax:
Mailing address:
  • Phone: 650-589-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD28487
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID TAI MAN SHEN
Title or Position: PRESIDENT/OWNER
Credential: DMD
Phone: 650-589-4563