Healthcare Provider Details

I. General information

NPI: 1962896936
Provider Name (Legal Business Name): AMY SIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

481 S WISHING WELL LN
ANAHEIM CA
92807-3541
US

V. Phone/Fax

Practice location:
  • Phone: 714-323-7874
  • Fax:
Mailing address:
  • Phone: 714-323-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number73502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: