Provider Demographics
NPI:1053599456
Name:SHON, ANDREW MIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MIN
Last Name:SHON
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 1:4460 WILSHIRE BLVD APT 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3733
Mailing Address - Country:US
Mailing Address - Phone:323-939-0902
Mailing Address - Fax:
Practice Address - Street 1:4460 WILSHIRE BLVD APT 703
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3733
Practice Address - Country:US
Practice Address - Phone:323-939-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist