Provider Demographics
NPI:1043258171
Name:TONY K SHUM, M.D. INC
Entity Type:Organization
Organization Name:TONY K SHUM, M.D. INC
Other - Org Name:DSC LASER & SKIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-285-0800
Mailing Address - Street 1:889 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2724
Mailing Address - Country:US
Mailing Address - Phone:626-285-0800
Mailing Address - Fax:626-285-0830
Practice Address - Street 1:889 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2724
Practice Address - Country:US
Practice Address - Phone:626-285-0800
Practice Address - Fax:626-285-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40567207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G405671Medicaid
CA00G405671Medicaid
CAW13413Medicare ID - Type Unspecified