1982819702 NPI number — MERRILL K SHUM M.D.

Table of content: MERRILL K SHUM M.D. (NPI 1982819702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982819702 NPI number — MERRILL K SHUM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUM
Provider First Name:
MERRILL
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1982819702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18000 STUDEBAKER RD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-2671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-735-3226
Provider Business Mailing Address Fax Number:
562-869-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8135 PAINTER AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90602-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-698-6888
Provider Business Practice Location Address Fax Number:
562-698-5855
Provider Enumeration Date:
05/14/2007

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: 207RH0003X , with the licence number:  MD428611 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: A98845 , 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)





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