Healthcare Provider Details

I. General information

NPI: 1003029927
Provider Name (Legal Business Name): SHEN LING D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

23244 HAWTHORNE BLVD
TORRANCE CA
90505-3719
US

IV. Provider business mailing address

25 HORSESHOE LANE
ROLLING HILLS ESTATES CA
90274
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-8520
  • Fax: 310-373-0621
Mailing address:
  • Phone: 310-377-6162
  • Fax: 310-377-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number42742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: