Provider Demographics
NPI:1497076780
Name:ADVANCED SPECIALTY ANESTHESIA & PAIN MANAGEMENT, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED SPECIALTY ANESTHESIA & PAIN MANAGEMENT, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-310-5817
Mailing Address - Street 1:219 W 7TH ST
Mailing Address - Street 2:207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1950
Mailing Address - Country:US
Mailing Address - Phone:310-310-5817
Mailing Address - Fax:310-496-0183
Practice Address - Street 1:219 W 7TH ST
Practice Address - Street 2:207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-1950
Practice Address - Country:US
Practice Address - Phone:310-310-5817
Practice Address - Fax:310-496-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75155207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty