Shufang Tan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS108707 Issued in CA

Practice address

15850 Soquel Canyon Pkwy Ste a
Chino Hills, CA 91709-5874

Phone

(909) 375-0133

NPI assigned

Jul 20, 2022

Last updated

May 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Qurban Dental Corproation

  dba The Dental Office On Soquel Canyon

  • General Practice Dentistry
  • Chino Hills, CA
  • NPI 1538677604
  NPD (past)

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1528793858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15850 SOQUEL CANYON PKWY STE A",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095874",
            "telephone_number": "909-375-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15850 SOQUEL CANYON PKWY STE A",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095874",
            "telephone_number": "909-375-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "SHUFANG",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-20",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN27044",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS108707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kanit Tachasooksaree
• Taka T Fujimura DDS, Inc.
• Casey Tamanaha
• Tammy C. Shinen, O.D., Inc.
• Mildred Q Tan
• Amy Tang
• Tai Tang, LVN
• Nihar D Tanna, D.D.S.,M.S.
• Nayomi Champagne Calangi Tashiro
• Leslie Wan-Yi Tay, DMD

• General Practice Dentistry in Chino Hills, CA
• Providers in Chino Hills, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.