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General NPI Number Information
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NPI Number | 1669620142
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Entity Type | Individual
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Provider Name | JAE HYUN SHIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 320 SUPERIOR AVE STE 370
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2795
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Country | US
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Telephone | 949-515-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 33 LACEBARK
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City | IRVINE
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State | CA
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Zip | 92618-2243
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Country | US
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Telephone | 585-478-4654
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | C196708
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License Number State | CA
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