Provider Demographics
NPI:1225396344
Name:SHIN, WONITA
Entity Type:Individual
Prefix:
First Name:WONITA
Middle Name:
Last Name:SHIN
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 1:314 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-274-1668
Practice Address - Fax:253-274-1685
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60648175207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program