Provider Demographics
NPI:1932469137
Name:QAYYUM, SHAMOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAMOON
Middle Name:
Last Name:QAYYUM
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 1:9281 CHAPMAN AVE
Mailing Address - Street 2:APT # 203
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2547
Mailing Address - Country:US
Mailing Address - Phone:714-299-7265
Mailing Address - Fax:
Practice Address - Street 1:9281 CHAPMAN AVE
Practice Address - Street 2:APARTMENT # 203
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2547
Practice Address - Country:US
Practice Address - Phone:714-299-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist