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General NPI Number Information
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NPI Number | 1275824971
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Entity Type | Individual
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Provider Name | MARIE WONKYONG SHIN DPM
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Gender | Female
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD STE 203
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1916
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Country | US
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Telephone | 714-620-4699
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Fax | 888-866-7055
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Provider Business Mailing Address
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Address Line | 12665 GARDEN GROVE BLVD STE 203
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1916
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Country | US
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Telephone | 714-620-4699
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Fax | 888-866-7055
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5711
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 5711
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License Number State | CA
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