Itien Emily Shaw, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS102837 Issued in CA

Practice address

4170 Truxel Rd Ste C
Sacramento, CA 95834-3758

Phone

(844) 673-9131

Fax

(916) 419-4582

NPI assigned

Apr 13, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 2, 2018 through Oct 2, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jagdev Singh Heir,MD a Professional Corporation

  • Ambulatory Surgical Clinic/Center
  • Sacramento, CA
  • NPI 1649434515

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1033409834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 TRUXEL RD STE C",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958343758",
            "telephone_number": "844-673-9131",
            "fax_number": "916-419-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 TRUXEL RD STE C",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958343758",
            "telephone_number": "844-673-9131",
            "fax_number": "916-419-4582"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 Plumas St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Yuba City",
            "state": "CA",
            "postal_code": "959913453",
            "country_code": "US",
            "telephone_number": "844-673-9131",
            "fax_number": "530-673-0162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ITIEN",
        "middle_name": "EMILY",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS102837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Domonique Casper Shaw, PH.D.
• Gail Naomi Shaw, M.D.
• Galen Wayne Shaw Jr.
• Heather Rene Shaw
• I-Tsyr Shaw, MD
• Kioweun Shaw, RN
• Lyndi Elizabeth Shaw, M.A.
• Mary E Shaw, MA,CCC-SLP
• Regina Ann Shaw, M.D.
• Sally Erin Shaw, R.N., P.H.N.

• Oral and Maxillofacial Surgery (Dentist) in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.