Provider Demographics
NPI:1730592437
Name:SHUM, JUSTINE (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:
Last Name:SHUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ROWLAND WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5057
Mailing Address - Country:US
Mailing Address - Phone:415-464-9604
Mailing Address - Fax:
Practice Address - Street 1:75 ROWLAND WAY STE 101
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5057
Practice Address - Country:US
Practice Address - Phone:415-464-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163211207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology