1033345905 NPI number — MS. YONG CHUN SHA LC.A

Table of content: MS. YONG CHUN SHA LC.A (NPI 1033345905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033345905 NPI number — MS. YONG CHUN SHA LC.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHA
Provider First Name:
YONG
Provider Middle Name:
CHUN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LC.A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHA
Provider Other First Name:
ANNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LC.A
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033345905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUPERTINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95015-2746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-585-8770
Provider Business Mailing Address Fax Number:
408-773-8961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 S MARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94087-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-585-8770
Provider Business Practice Location Address Fax Number:
408-773-8961
Provider Enumeration Date:
06/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  12965 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)