Provider Demographics
NPI:1902006836
Name:SHI, ANDREW BEIHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BEIHONG
Last Name:SHI
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 1:2 CARTIER AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-5708
Mailing Address - Country:US
Mailing Address - Phone:415-503-7584
Mailing Address - Fax:949-770-4707
Practice Address - Street 1:22421 EL TORO RD
Practice Address - Street 2:SUITE E
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5049
Practice Address - Country:US
Practice Address - Phone:949-770-4707
Practice Address - Fax:949-770-4708
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55838Medicaid