Healthcare Provider Details

I. General information

NPI: 1467373704
Provider Name (Legal Business Name): JULIA SHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 TRAUTWEIN RD STE A
RIVERSIDE CA
92508-9474
US

IV. Provider business mailing address

7871 MISSION GROVE PKWY S APT 12
RIVERSIDE CA
92508-5027
US

V. Phone/Fax

Practice location:
  • Phone: 951-776-1330
  • Fax:
Mailing address:
  • Phone: 213-435-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: