Provider Demographics
NPI:1689742082
Name:WEN, SHUMIN (DDS)
Entity Type:Individual
Prefix:
First Name:SHUMIN
Middle Name:
Last Name:WEN
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 1:1038 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6949
Mailing Address - Country:US
Mailing Address - Phone:626-445-7882
Mailing Address - Fax:626-445-7882
Practice Address - Street 1:355 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3327
Practice Address - Country:US
Practice Address - Phone:323-751-4100
Practice Address - Fax:323-751-2853
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice