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General NPI Number Information
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NPI Number | 1174306286
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Entity Type | Individual
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Provider Name | SUJI SHIN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 12325 HYMEADOW DR # 2-100101
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City | AUSTIN
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State | TX
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Zip | 78750-1879
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Country | US
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Telephone | 979-224-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 12325 HYMEADOW DR # 2-100101
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City | AUSTIN
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State | TX
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Zip | 78750-1879
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Country | US
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Telephone | 979-224-6802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State | TX
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