Healthcare Provider Details

I. General information

NPI: 1497216360
Provider Name (Legal Business Name): HA YEON SHIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9833 PACIFIC HEIGHTS BLVD STE J
SAN DIEGO CA
92121-4707
US

IV. Provider business mailing address

9850 GENESEE AVE STE 710
LA JOLLA CA
92037-1218
US

V. Phone/Fax

Practice location:
  • Phone: 858-458-0940
  • Fax: 858-458-3688
Mailing address:
  • Phone: 858-260-2977
  • Fax: 858-260-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA185748
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA185748
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA185748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: