Provider Demographics
NPI:1568769149
Name:SHIN, BO KYONG (DPM)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:KYONG
Last Name:SHIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 SHATTO PL # 351A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1723
Mailing Address - Country:US
Mailing Address - Phone:404-825-8099
Mailing Address - Fax:888-866-7055
Practice Address - Street 1:4618 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1830
Practice Address - Country:US
Practice Address - Phone:323-953-7170
Practice Address - Fax:323-663-2379
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006460213E00000X
NJ25MD00308100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty