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General NPI Number Information
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NPI Number | 1588553457
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Entity Type | Organization
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Legal Business Name | SHORE HIP AND JOINT
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 4551 GLENCOE AVE STE 145
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6385
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Country | US
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Telephone | 310-773-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD PMB 389286
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 617-686-7177
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | BRETT SHORE
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Credential | MD
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Telephone | 617-686-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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