Provider Demographics
NPI:1063040228
Name:YONG SOON SHIN RN NP A NURSING CORPORATION
Entity Type:Organization
Organization Name:YONG SOON SHIN RN NP A NURSING CORPORATION
Other - Org Name:VITA PLUS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:YONG
Authorized Official - Middle Name:SOON
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-349-7347
Mailing Address - Street 1:1817 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4405
Mailing Address - Country:US
Mailing Address - Phone:714-449-0911
Mailing Address - Fax:
Practice Address - Street 1:1817 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4405
Practice Address - Country:US
Practice Address - Phone:714-449-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005514Medicaid