Provider Demographics
NPI:1326060179
Name:SHIN, CHRIS CHANGEUN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:CHANGEUN
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S BEACH BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1878
Mailing Address - Country:US
Mailing Address - Phone:714-577-2340
Mailing Address - Fax:714-710-1197
Practice Address - Street 1:408 S BEACH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1878
Practice Address - Country:US
Practice Address - Phone:714-577-2340
Practice Address - Fax:714-710-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61649207R00000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A616490Medicaid
CA00A616490Medicaid