1679069694 NPI number — SHIOW JIIN JAW, DDS, INC.

Table of content: (NPI 1679069694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679069694 NPI number — SHIOW JIIN JAW, DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIOW JIIN JAW, DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679069694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2848 CUMBERLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91108-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-817-2037
Provider Business Mailing Address Fax Number:
626-766-1612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6270 ROSEMEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-622-8646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAW
Authorized Official First Name:
SHIOW JIIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-817-2037

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  38304 , 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)