Provider Demographics
NPI:1780769299
Name:SHAM, CHI YUN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHI
Middle Name:YUN
Last Name:SHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHI-YUN
Other - Middle Name:
Other - Last Name:SHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:463 WORCESTER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5354
Mailing Address - Country:US
Mailing Address - Phone:508-820-7792
Mailing Address - Fax:
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5354
Practice Address - Country:US
Practice Address - Phone:508-820-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice