Healthcare Provider Details

I. General information

NPI: 1346683208
Provider Name (Legal Business Name): YOHAN SHIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CALIFORNIA ST
REDLANDS CA
92374-2910
US

IV. Provider business mailing address

1301 CALIFORNIA ST
REDLANDS CA
92374-2910
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A14125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: