Provider Demographics
NPI:1578737789
Name:SHIN, YOUNGHO (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNGHO
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18002 OUTER HIGHWAY 18
Mailing Address - Street 2:SUITE #A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-4579
Mailing Address - Fax:760-242-4762
Practice Address - Street 1:18002 OUTER HIGHWAY 18
Practice Address - Street 2:SUITE #A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-4579
Practice Address - Fax:760-242-4762
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist