Provider Demographics
NPI:1326495250
Name:SHAWN CRUM, D.O., M.P.H. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SHAWN CRUM, D.O., M.P.H. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:714-698-9042
Mailing Address - Street 1:16787 BEACH BLVD
Mailing Address - Street 2:#337
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4848
Mailing Address - Country:US
Mailing Address - Phone:714-903-7767
Mailing Address - Fax:714-903-7801
Practice Address - Street 1:16787 BEACH BLVD
Practice Address - Street 2:#337
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4848
Practice Address - Country:US
Practice Address - Phone:714-903-7767
Practice Address - Fax:714-903-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty