Provider Demographics
NPI:1558556688
Name:SHIN, SUNG (DC)
Entity Type:Individual
Prefix:MRS
First Name:SUNG
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23341 GOLDEN SPRINGS DR
Mailing Address - Street 2:SUITE #106
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2058
Mailing Address - Country:US
Mailing Address - Phone:909-861-7023
Mailing Address - Fax:
Practice Address - Street 1:23341 GOLDEN SPRINGS DR
Practice Address - Street 2:SUITE #106
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2058
Practice Address - Country:US
Practice Address - Phone:909-861-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51699Medicare UPIN