Provider Demographics
NPI:1366424475
Name:SHUM, RICHARD WAI CHOY (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAI CHOY
Last Name:SHUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 S ARCHER AVE
Mailing Address - Street 2:STE B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1514
Mailing Address - Country:US
Mailing Address - Phone:312-567-0194
Mailing Address - Fax:312-567-0197
Practice Address - Street 1:2124 S ARCHER AVE
Practice Address - Street 2:STE B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1514
Practice Address - Country:US
Practice Address - Phone:312-567-0194
Practice Address - Fax:312-567-0197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist