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General NPI Number Information
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NPI Number | 1194660506
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Entity Type | Individual
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Provider Name | SINJIN BLACK
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Gender | Male
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 1200 SW 104TH ST STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-3018
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Country | US
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Telephone | 405-759-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 3012 SHADOWHILL ST
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City | NORMAN
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State | OK
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Zip | 73071-7189
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Country | US
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Telephone | 405-371-0226
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3965
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License Number State | OK
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