MEDICARE: SHIN'S MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	W22468	CA

General Provider Information

NPI Number	:	1427224799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIN'S MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	3030 W OLYMPIC BLVD
Second Line	:	220
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6501
Country	:	US
Telephone Number	:	213-738-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 W OLYMPIC BLVD
Second Line	:	220
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6501
Country	:	US
Telephone Number	:	213-738-7788
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONG W SHIN
Credential	:
Telephone Number	:	213-738-7788

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	08/11/2008

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Directions to “SHIN'S MEDICAL GROUP INC ” Practice Location

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