Provider Demographics
NPI:1386342293
Name:SHUM, CHING YEE
Entity type:Individual
Prefix:
First Name:CHING YEE
Middle Name:
Last Name:SHUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 ENCINAL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4353
Mailing Address - Country:US
Mailing Address - Phone:510-213-9214
Mailing Address - Fax:
Practice Address - Street 1:2128 ENCINAL AVE APT C
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4353
Practice Address - Country:US
Practice Address - Phone:510-213-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86090488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered