=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184843054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHUN-YU NIEH D.D.S. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10210 W MCDOWELL RD STE. #140
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-478-5435
-----------------------------------------------------
Fax | 623-478-5433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10210 W MCDOWELL RD STE. #140
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-478-5435
-----------------------------------------------------
Fax | 623-478-5433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHUNYU NIEH
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 623-478-5435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------