MEDICARE: JANE SHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	64491	CA

General Provider Information

NPI Number	:	1114327947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE SHIN

Provider Business Mailing Address
First Line	:	14271 JEFFREY RD # 144
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22982 EL TORO RD STE 100
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4919
Country	:	US
Telephone Number	:	949-305-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	02/18/2024

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