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General NPI Number Information
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NPI Number | 1801186812
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Entity Type | Organization
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Legal Business Name | HURON SHORES LLC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 2415 STONECROP WAY
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City | GOLDEN
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State | CO
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Zip | 80401-8526
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Country | US
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Telephone | 888-462-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 STONECROP WAY
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City | GOLDEN
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State | CO
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Zip | 80401-8526
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Country | US
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Telephone | 888-462-9142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID WONG
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Credential | MD
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Telephone | 888-492-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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