MEDICARE: EMILY 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	163WC0200X	Critical Care Medicine Registered Nurse	771461	CA
2	163WG0000X	General Practice Registered Nurse	771461	CA

General Provider Information

NPI Number	:	1790620912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SHIN

Provider Business Mailing Address
First Line	:	901 S GRAMERCY DR UNIT 402
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S GRAMERCY DR UNIT 402
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2291
Country	:	US
Telephone Number	:	213-505-8142
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ EMILY SHIN ” Practice Location

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