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General NPI Number Information
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NPI Number | 1922139757
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Entity Type | Organization
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Legal Business Name | TAE M SHIN, M.D. INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4220 W 3RD ST SUITE #208
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City | LOS ANGELES
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State | CA
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Zip | 90020-3450
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Country | US
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Telephone | 213-386-3554
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Fax | 805-991-4065
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Provider Business Mailing Address
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Address Line | PO BOX 65
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City | SIMI VALLEY
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State | CA
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Zip | 93062-0065
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Country | US
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Telephone | 805-577-8730
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Fax | 805-991-4065
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Authorized Official
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Title or Position | DIRECTOR OF BILLING OPERATIONS
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Name | MISS ROSE MARIE RIVERA
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Credential |
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Telephone | 805-577-8730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | G85170
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License Number State | CA
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