Provider Demographics
NPI:1225693989
Name:SHIN, PAUL H
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:H
Last Name:SHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E KAWILI ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5063
Mailing Address - Country:US
Mailing Address - Phone:903-513-7466
Mailing Address - Fax:
Practice Address - Street 1:34 E KAWILI ST APT 3
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5063
Practice Address - Country:US
Practice Address - Phone:903-513-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBACB497513106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician