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NPI Code Detail

MEDICARE: DR. SOOK-JA SHIN M.D.

MEDICARE: DR. SOOK-JA SHIN M.D.
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
1207L00000XAnesthesiology PhysicianA37091CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881641892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOOK-JA SHIN M.D.
Provider Business Mailing Address
First Line : 1510 EL NITA LN
Second Line :
City : HEMET
State : CA
Zip : 92544-4603
Country : US
Telephone Number : 951-929-6260
Fax Number : 951-765-2855
Provider Business Practice Location Address
First Line : 1805 MEDICAL CENTER DR
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92411-1217
Country : US
Telephone Number : 909-887-6333
Fax Number : 909-806-1017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 04/09/2014

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