Provider Demographics
NPI:1891316147
Name:SHUM ELLINGTON, KATHY (DO)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHUM ELLINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:SHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1135 N BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4114
Mailing Address - Country:US
Mailing Address - Phone:214-942-3100
Mailing Address - Fax:214-942-3100
Practice Address - Street 1:1135 N BISHOP AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4114
Practice Address - Country:US
Practice Address - Phone:214-942-3100
Practice Address - Fax:214-942-3100
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV1617207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program