Provider Demographics
NPI:1114687290
Name:YOON, SHINHAE
Entity Type:Individual
Prefix:
First Name:SHINHAE
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5791
Mailing Address - Country:US
Mailing Address - Phone:831-636-1691
Mailing Address - Fax:
Practice Address - Street 1:1701 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5791
Practice Address - Country:US
Practice Address - Phone:831-636-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist