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General NPI Number Information
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NPI Number | 1952794349
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Entity Type | Organization
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Legal Business Name | SHIN MEDICAL GROUP
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 400 SHADOW LN STE 205
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City | LAS VEGAS
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State | NV
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Zip | 89106-4358
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Country | US
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Telephone | 702-631-5000
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Fax | 702-631-5002
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Provider Business Mailing Address
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Address Line | 11044 SONOMA CREEK CT
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City | LAS VEGAS
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State | NV
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Zip | 89144-4020
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Country | US
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Telephone | 702-334-6847
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLIOT SHIN
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Credential | M.D.
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Telephone | 702-334-6847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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