Healthcare Provider Details

I. General information

NPI: 1235689175
Provider Name (Legal Business Name): SHIN IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 SUNNYCREST DR STE 110
FULLERTON CA
92835-3653
US

IV. Provider business mailing address

1955 SUNNY CREST DR STE 110
FULLERTON CA
92835-3653
US

V. Phone/Fax

Practice location:
  • Phone: 310-995-6689
  • Fax:
Mailing address:
  • Phone: 714-578-8882
  • Fax: 714-578-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES J MALONEY
Title or Position: PRESIDENT
Credential:
Phone: 310-995-6689