Healthcare Provider Details

I. General information

NPI: 1679762736
Provider Name (Legal Business Name): EIN SOON SHIN LIC. AC., PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD STE 202
BEVERLY HILLS CA
90212-2031
US

IV. Provider business mailing address

9730 WILSHIRE BLVD STE 202
BEVERLY HILLS CA
90212-2031
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-9910
  • Fax:
Mailing address:
  • Phone: 310-247-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: