Provider Demographics
NPI:1427224799
Name:SHIN'S MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SHIN'S MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONG
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-738-7788
Mailing Address - Street 1:3030 W OLYMPIC BLVD
Mailing Address - Street 2:220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6501
Mailing Address - Country:US
Mailing Address - Phone:213-738-7788
Mailing Address - Fax:
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-738-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW22468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22468Medicare PIN