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General NPI Number Information
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NPI Number | 1033409834
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Entity Type | Individual
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Provider Name | ITIEN EMILY SHAW DDS, MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 4170 TRUXEL RD STE C
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City | SACRAMENTO
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State | CA
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Zip | 95834-3758
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Country | US
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Telephone | 844-673-9131
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Fax | 916-419-4582
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Provider Business Mailing Address
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Address Line | 4170 TRUXEL RD STE C
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City | SACRAMENTO
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State | CA
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Zip | 95834-3758
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Country | US
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Telephone | 844-673-9131
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Fax | 916-419-4582
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DDS102837
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License Number State | CA
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