Provider Demographics
NPI:1063983625
Name:PETER K SHEK
Entity type:Organization
Organization Name:PETER K SHEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-875-2307
Mailing Address - Street 1:1401 S ANAHEIM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6246
Mailing Address - Country:US
Mailing Address - Phone:714-772-9800
Mailing Address - Fax:
Practice Address - Street 1:1401 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6246
Practice Address - Country:US
Practice Address - Phone:714-772-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty