Provider Demographics
NPI:1861413858
Name:NGHIEM-SHUM, CATHERINE (DC LAC QME)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:NGHIEM-SHUM
Suffix:
Gender:F
Credentials:DC LAC QME
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:NGHIEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC LAC QME
Mailing Address - Street 1:4879 MISSION STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-584-3042
Mailing Address - Fax:415-584-3052
Practice Address - Street 1:4879 MISSION STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-584-3042
Practice Address - Fax:415-584-3052
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27496111N00000X
CAAC8015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94641Medicare UPIN
CAZZZ65070ZMedicare ID - Type Unspecified
CAZZZ07985ZMedicare ID - Type Unspecified