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NPI Code Detail

MEDICARE: DR. JONATHAN W SHUM MD, DDS

MEDICARE: DR. JONATHAN W SHUM MD, DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204E00000XOral & Maxillofacial Surgery (D.M.D.)D73838MD
2204E00000XOral & Maxillofacial Surgery (D.M.D.)FE156073OR
3204E00000XOral & Maxillofacial Surgery (D.M.D.)P7351TX

General Provider Information

NPI Number : 1518110329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN W SHUM MD, DDS
Provider Business Mailing Address
First Line : 6560 FANNIN ST STE 1900
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2785
Country : US
Telephone Number : 713-790-4600
Fax Number : 713-729-1229
Provider Business Practice Location Address
First Line : 6560 FANNIN ST STE 1900
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2785
Country : US
Telephone Number : 713-790-4600
Fax Number : 713-729-1229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2008
Last Update Date : 03/17/2018

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