Healthcare Provider Details

I. General information

NPI: 1255473575
Provider Name (Legal Business Name): CARL HYUN-GEOL SHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 ARDEN WAY STE 301
SACRAMENTO CA
95825-2482
US

IV. Provider business mailing address

2424 ARDEN WAY STE 301
SACRAMENTO CA
95825-2482
US

V. Phone/Fax

Practice location:
  • Phone: 916-977-0741
  • Fax: 916-977-0547
Mailing address:
  • Phone: 916-977-0741
  • Fax: 916-977-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA60900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA60900
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA60900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: