Provider Demographics
NPI:1528793858
Name:TAN, SHUFANG (DMD)
Entity type:Individual
Prefix:
First Name:SHUFANG
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15850 SOQUEL CANYON PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5874
Mailing Address - Country:US
Mailing Address - Phone:909-375-0133
Mailing Address - Fax:
Practice Address - Street 1:15850 SOQUEL CANYON PKWY STE A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5874
Practice Address - Country:US
Practice Address - Phone:909-375-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN270441223G0001X
CADDS1087071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice