Provider Demographics
NPI:1982915799
Name:XU, SHAUN XUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:XUN
Last Name:XU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:XUN
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3600
Mailing Address - Country:US
Mailing Address - Phone:626-627-6249
Mailing Address - Fax:626-280-4632
Practice Address - Street 1:2111 SAN GABRIEL BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-3600
Practice Address - Country:US
Practice Address - Phone:626-627-6249
Practice Address - Fax:626-280-4632
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist