=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831350768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY HEEEUN SHIN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVE
-----------------------------------------------------
City | JOINT BASE LEWIS MCCHORD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 M ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | MD60602836
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------