Provider Demographics
NPI:1497148498
Name:SHIN, YOUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7325
Mailing Address - Country:US
Mailing Address - Phone:619-298-5181
Mailing Address - Fax:
Practice Address - Street 1:1020 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7325
Practice Address - Country:US
Practice Address - Phone:619-298-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68233OtherCALIFORNIA PHARMACY LICENSE