Provider Demographics
NPI:1265850424
Name:SHUEN FAMILY DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:SHUEN FAMILY DENTAL GROUP, INC.
Other - Org Name:KIMBER PARK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-661-0788
Mailing Address - Street 1:39812 MISSION BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3088
Mailing Address - Country:US
Mailing Address - Phone:510-661-0788
Mailing Address - Fax:510-870-0687
Practice Address - Street 1:39812 MISSION BLVD STE 109
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3088
Practice Address - Country:US
Practice Address - Phone:510-661-0788
Practice Address - Fax:510-870-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44777261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental