=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801090188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL SHIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2007
-----------------------------------------------------
Last Update Date | 04/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 WILSHIRE BLVD 804
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-623-5125
-----------------------------------------------------
Fax | 310-496-0183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1930 WILSHIRE BLVD 804
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-623-5125
-----------------------------------------------------
Fax | 310-496-0183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | G75155
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | G075155
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------