Basic Information
| Provider Information | |||||||||
| NPI: | 1609061191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUM | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | MENG-TAH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 959 E WALNUT ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267951831 | ||||||||
| FaxNumber: | 6267952716 | ||||||||
| Practice Location | |||||||||
| Address1: | 959 E WALNUT ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267951831 | ||||||||
| FaxNumber: | 6267952716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2007 | ||||||||
| LastUpdateDate: | 09/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MT188668 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RP1001X | A121518 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | A121518 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | W481 | 01 | MEDICARE GROUP NUMBER | OTHER |