Provider Demographics
NPI:1295841377
Name:SHIN MRI LLC
Entity Type:Organization
Organization Name:SHIN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYUNGJA
Authorized Official - Middle Name:SHIN
Authorized Official - Last Name:ELKJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-3002
Mailing Address - Street 1:266 S HARVARD BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4339
Mailing Address - Country:US
Mailing Address - Phone:213-387-3002
Mailing Address - Fax:
Practice Address - Street 1:266 S HARVARD BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4339
Practice Address - Country:US
Practice Address - Phone:213-387-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG228Medicare ID - Type Unspecified