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1881665099 NPI number — SE JUNG SHIN M.D.

NPI Number: 1881665099
Health Care Provider/Practitioner: SE JUNG SHIN M.D.

Information about “1881665099” NPI (SE JUNG SHIN M.D.) exists in 1881665099 in HTML format HTML  |  1881665099 in plain Text format TXT  |  1881665099 in PDF (Portable Document Format) PDF  |  1881665099 in an XML format XML  formats.

NPI Number : 1881665099 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881665099",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIN",
    "FirstName": "SE JUNG",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3600 LIND AVE SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RENTON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98057-4934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "425-228-3440",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10555 SE CARR RD BLDG M",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RENTON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98055-5820",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-656-4270",
    "PracticeLocationAddressFaxNumber": "425-656-4271",
    "EnumerationDate": "01/27/2006",
    "LastUpdateDate": "04/30/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "MD22180",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "MD00038373",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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