Healthcare Provider Details

I. General information

NPI: 1003793803
Provider Name (Legal Business Name): MSHIN ACADEMIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 173RD AVE NE
REDMOND WA
98052-6049
US

IV. Provider business mailing address

2321 173RD AVE NE
REDMOND WA
98052-6049
US

V. Phone/Fax

Practice location:
  • Phone: 425-449-2060
  • Fax:
Mailing address:
  • Phone: 425-449-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MEERA SHIN
Title or Position: DIRECTOR
Credential:
Phone: 425-449-2060