Provider Demographics
NPI:1780847095
Name:JOU, SHUING GUANG (DMD)
Entity Type:Individual
Prefix:
First Name:SHUING
Middle Name:GUANG
Last Name:JOU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 NOGALES ST
Mailing Address - Street 2:#3-6
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2251
Mailing Address - Country:US
Mailing Address - Phone:626-964-3288
Mailing Address - Fax:626-964-2595
Practice Address - Street 1:1457 NOGALES ST
Practice Address - Street 2:#3-6
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2251
Practice Address - Country:US
Practice Address - Phone:626-964-3288
Practice Address - Fax:626-964-2595
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41429-01OtherMEDI-CAL