Provider Demographics
NPI:1033223045
Name:HO, SHIN PIN (MD)
Entity Type:Individual
Prefix:
First Name:SHIN
Middle Name:PIN
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27141 HIDAWAY AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4135
Mailing Address - Country:US
Mailing Address - Phone:661-252-8469
Mailing Address - Fax:661-252-6506
Practice Address - Street 1:27141 HIDAWAY AVE
Practice Address - Street 2:STE 106
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-4135
Practice Address - Country:US
Practice Address - Phone:661-252-8469
Practice Address - Fax:661-252-6506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32362207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A323620Medicaid
CAA32362AMedicare ID - Type Unspecified
CA00A323620Medicaid