Provider Demographics
NPI:1043744139
Name:SHON, JAMES S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:SHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 PLAYER LN
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1522
Mailing Address - Country:US
Mailing Address - Phone:213-284-2245
Mailing Address - Fax:
Practice Address - Street 1:12752 GARDEN GROVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1924
Practice Address - Country:US
Practice Address - Phone:714-636-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice