Healthcare Provider Details

I. General information

NPI: 1750483723
Provider Name (Legal Business Name): TAE MIN SHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD., SUITE 400
LOS ANGELES CA
90017
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 400
LOS ANGELES CA
90017-4810
US

V. Phone/Fax

Practice location:
  • Phone: 213-482-2992
  • Fax: 213-482-2999
Mailing address:
  • Phone: 213-482-2992
  • Fax: 213-482-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG85170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: