Provider Demographics
NPI:1225300973
Name:SHIN, EUNSHIK (DC)
Entity Type:Individual
Prefix:
First Name:EUNSHIK
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S VIRGIL AVE
Mailing Address - Street 2:STE 503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1452
Mailing Address - Country:US
Mailing Address - Phone:323-823-0715
Mailing Address - Fax:
Practice Address - Street 1:520 S VIRGIL AVE
Practice Address - Street 2:STE 503
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1452
Practice Address - Country:US
Practice Address - Phone:323-823-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor