Provider Demographics
NPI:1740228998
Name:SHUM, TONY K (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:K
Last Name:SHUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2724
Mailing Address - Country:US
Mailing Address - Phone:626-285-0800
Mailing Address - Fax:626-285-0830
Practice Address - Street 1:889 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2724
Practice Address - Country:US
Practice Address - Phone:626-285-0800
Practice Address - Fax:626-285-0830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40567207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G405671Medicaid
CAW13413Medicare ID - Type Unspecified
CAA48271Medicare UPIN