Healthcare Provider Details

I. General information

NPI: 1497987143
Provider Name (Legal Business Name): MIKE S. SHIN M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 W. SEVENTH ST.
HANFORD CA
93230-4926
US

IV. Provider business mailing address

860 W. SEVENTH ST.
HANFORD CA
93230-4926
US

V. Phone/Fax

Practice location:
  • Phone: 559-585-7252
  • Fax: 559-585-7253
Mailing address:
  • Phone: 559-585-7252
  • Fax: 559-585-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA975160
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA975160
License Number StateCA

VIII. Authorized Official

Name: MIKE S. SHIN
Title or Position: PHYSICAN/OWNER
Credential: M.D.
Phone: 559-585-7252