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General NPI Number Information
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NPI Number | 1841791274
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Entity Type | Organization
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Legal Business Name | SJS, PLLC
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 900 OCEAN BEACH HWY STE B
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City | LONGVIEW
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State | WA
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Zip | 98632-4013
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Country | US
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Telephone | 360-646-8860
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Fax | 360-646-8865
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Provider Business Mailing Address
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Address Line | 29640 MARINE VIEW DR SW
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City | FEDERAL WAY
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State | WA
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Zip | 98023-3400
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Country | US
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Telephone | 360-646-8860
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Fax | 360-646-8865
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEJUNG SHIN
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Credential | MD
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Telephone | 503-502-6097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10003271
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD00038373WA
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License Number State | WA
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