Healthcare Provider Details

I. General information

NPI: 1841791274
Provider Name (Legal Business Name): SJS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OCEAN BEACH HWY STE B
LONGVIEW WA
98632-4013
US

IV. Provider business mailing address

29640 MARINE VIEW DR SW
FEDERAL WAY WA
98023-3400
US

V. Phone/Fax

Practice location:
  • Phone: 360-646-8860
  • Fax: 360-646-8865
Mailing address:
  • Phone: 360-646-8860
  • Fax: 360-646-8865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00038373WA
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003271
License Number StateWA

VIII. Authorized Official

Name: DR. SEJUNG SHIN
Title or Position: PRESIDENT
Credential: MD
Phone: 503-502-6097