Healthcare Provider Details

I. General information

NPI: 1659550911
Provider Name (Legal Business Name): VICTORIA SHIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 TORRANCE BLVD STE A
TORRANCE CA
90503-5800
US

IV. Provider business mailing address

3475 TORRANCE BLVD STE A
TORRANCE CA
90503-5800
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-3568
  • Fax: 310-316-9188
Mailing address:
  • Phone: 310-370-3568
  • Fax: 310-316-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA75292
License Number StateCA

VIII. Authorized Official

Name: VICTORIA Y SHIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-990-1131