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General NPI Number Information
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NPI Number | 1982628756
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Entity Type | Individual
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Provider Name | ANTHONY S SHIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 12000 MOUNT VERNON AVE
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5174
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Country | US
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Telephone | 951-273-0136
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Fax | 951-848-9121
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Provider Business Mailing Address
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Address Line | PO BOX 946
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City | LOMA LINDA
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State | CA
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Zip | 92354-0946
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Country | US
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Telephone | 951-273-0136
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Fax | 951-848-9121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A42601
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License Number State | CA
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