Provider Demographics
NPI:1891316147
Name:SHUM ELLINGTON, KATHY (DO)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHUM ELLINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1441 N. BECKLEY AVE
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-947-6700
Mailing Address - Fax:214-947-6701
Practice Address - Street 1:122 W. COLORADO BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-947-6700
Practice Address - Fax:214-947-6701
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program