Provider Demographics
NPI:1609977529
Name:SHICK, SEAN (SONOGRAPHER)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:SHICK
Suffix:
Gender:M
Credentials:SONOGRAPHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 S BRISTOL ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6233
Mailing Address - Country:US
Mailing Address - Phone:714-979-5781
Mailing Address - Fax:714-979-5781
Practice Address - Street 1:2740 S BRISTOL ST STE 208
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6233
Practice Address - Country:US
Practice Address - Phone:714-979-5781
Practice Address - Fax:714-979-5781
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291652471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29165OtherSONOGRAPHER LICENSE