Provider Demographics
NPI:1891529327
Name:QIAN, SHAN
Entity type:Individual
Prefix:
First Name:SHAN
Middle Name:
Last Name:QIAN
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 1:15920 POMONA RINCON RD UNIT 7802
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5543
Mailing Address - Country:US
Mailing Address - Phone:949-537-6723
Mailing Address - Fax:
Practice Address - Street 1:13334 LIMONITE AVE STE 120
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-7257
Practice Address - Country:US
Practice Address - Phone:951-228-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist