Healthcare Provider Details

I. General information

NPI: 1134484165
Provider Name (Legal Business Name): SEUNG H SHIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 30TH DR SE STE 220
BOTHELL WA
98021-7015
US

IV. Provider business mailing address

21540 30TH DR SE STE 220
BOTHELL WA
98021-7015
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0640
  • Fax: 206-341-0648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00040781
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: