Provider Demographics
NPI:1801973433
Name:SHANG, YING MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:YING
Middle Name:MATTHEW
Last Name:SHANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5095
Mailing Address - Country:US
Mailing Address - Phone:916-339-9000
Mailing Address - Fax:
Practice Address - Street 1:3901 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5095
Practice Address - Country:US
Practice Address - Phone:916-339-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice