MEDICARE: HANNAH HAESOO SHIN NP

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	363LA2100X	Acute Care Nurse Practitioner	95017907	CA

General Provider Information

NPI Number	:	1386304392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH HAESOO SHIN NP

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UCLA MEDICAL PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-4011
Country	:	US
Telephone Number	:	310-206-7663
Fax Number	:	310-794-9718

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

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/14/2022

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