Healthcare Provider Details

I. General information

NPI: 1134824303
Provider Name (Legal Business Name): MICHELLE SHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 BAY RD
EAST PALO ALTO CA
94303-1312
US

IV. Provider business mailing address

1146 KELEZ DR
SAN JOSE CA
95120-2858
US

V. Phone/Fax

Practice location:
  • Phone: 650-289-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: