Provider Demographics
NPI:1235485327
Name:SHIN, JAINEN (LAC)
Entity Type:Individual
Prefix:
First Name:JAINEN
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9478 W OLYMPIC BLVD PH
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4255
Mailing Address - Country:US
Mailing Address - Phone:949-342-6876
Mailing Address - Fax:
Practice Address - Street 1:9478 W OLYMPIC BLVD PH
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4255
Practice Address - Country:US
Practice Address - Phone:949-342-6876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14587171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist