Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | D73838 | MD |
N | 204E00000X | Oral & Maxillofacial Surgeon | FE156073 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | P7351 | TX |
NPI | 1518110329 |
---|---|
Provider Name | Dr. Jonathan W Shum |
First Address | Houston, TX 77030-2785 |
Second Address | Houston, TX 77030-2785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2008 |
Last Update Date | 17/03/2018 |