MEDICARE: CHRISTOPHER SHI DENTAL CORP

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1790648319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER SHI DENTAL CORP

Provider Business Mailing Address
First Line	:	17692 BEACH BLVD STE 209
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6810
Country	:	US
Telephone Number	:	714-842-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	17692 BEACH BLVD STE 209
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6810
Country	:	US
Telephone Number	:	714-842-7775
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. CHRISTOPHER SHI
Credential	:	DMD
Telephone Number	:	770-845-0727

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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