Healthcare Provider Details

I. General information

NPI: 1992115455
Provider Name (Legal Business Name): NICOLE B. SHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE B. KURATA M.D.

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 112TH AVE NE STE 100
BELLEVUE WA
98004-4509
US

IV. Provider business mailing address

1110 112TH AVE NE STE 100
BELLEVUE WA
98004-4509
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-8111
  • Fax:
Mailing address:
  • Phone: 425-688-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19463
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDR 6680
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number61131483
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: