=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497987143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIKE S. SHIN M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2009
-----------------------------------------------------
Last Update Date | 10/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 W. SEVENTH ST.
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-585-7252
-----------------------------------------------------
Fax | 559-585-7253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 860 W. SEVENTH ST.
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-585-7252
-----------------------------------------------------
Fax | 559-585-7253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAN/OWNER
-----------------------------------------------------
Name | MIKE S. SHIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-585-7252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | A975160
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | A975160
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------