Provider Demographics
NPI:1073966495
Name:BORNSTEIN, SHAUN (MTOM)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BAY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1130
Mailing Address - Country:US
Mailing Address - Phone:310-399-6583
Mailing Address - Fax:
Practice Address - Street 1:1807 WILSHIRE BLVD
Practice Address - Street 2:200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5652
Practice Address - Country:US
Practice Address - Phone:310-453-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist