Healthcare Provider Details

I. General information

NPI: 1548657364
Provider Name (Legal Business Name): THEODORE SIN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 BRITTANY DR
BATON ROUGE LA
70808
US

IV. Provider business mailing address

7865 VIA MONTEBELLO #4
SAN DIEGO CA
92129-5155
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-4140
  • Fax:
Mailing address:
  • Phone: 801-221-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number309548
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51950
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58137
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: