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NPI Code Detail

MEDICARE: ORI MICHAEL SHINE MD

MEDICARE: ORI MICHAEL SHINE MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1811837214
Entity Type Code : Individual
Provider Name (Legal Business Name) : ORI MICHAEL SHINE MD
Provider Business Mailing Address
First Line : 4077 FIFTH AVE # MER-35
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2105
Country : US
Telephone Number : 619-260-7220
Fax Number :
Provider Business Practice Location Address
First Line : 4077 FIFTH AVE # MER-35
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2105
Country : US
Telephone Number : 619-260-7220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ ORI MICHAEL SHINE MD” Practice Location

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