Healthcare Provider Details

I. General information

NPI: 1205272853
Provider Name (Legal Business Name): EDWARD C. SHIN, M.D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 EL CAMINO REAL STE 100
BURLINGAME CA
94010-3105
US

IV. Provider business mailing address

1838 EL CAMINO REAL STE 100
BURLINGAME CA
94010-3105
US

V. Phone/Fax

Practice location:
  • Phone: 415-346-1114
  • Fax: 415-634-0206
Mailing address:
  • Phone: 415-346-1114
  • Fax: 415-634-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA108147
License Number StateCA

VIII. Authorized Official

Name: EDWARD C. SHIN
Title or Position: CEO
Credential: M.D
Phone: 415-346-1114