Provider Demographics
NPI:1518110329
Name:SHUM, JONATHAN W (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:SHUM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2785
Mailing Address - Country:US
Mailing Address - Phone:713-790-4600
Mailing Address - Fax:713-729-1229
Practice Address - Street 1:6560 FANNIN ST STE 1900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2785
Practice Address - Country:US
Practice Address - Phone:713-790-4600
Practice Address - Fax:713-729-1229
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73838204E00000X
ORFE156073204E00000X
TXP7351204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery