Provider Demographics
NPI:1619694593
Name:SHINNEY, JOSHUA KIM
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KIM
Last Name:SHINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 E 5550 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4308
Mailing Address - Country:US
Mailing Address - Phone:801-475-4673
Mailing Address - Fax:
Practice Address - Street 1:1708 E 5550 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4308
Practice Address - Country:US
Practice Address - Phone:801-475-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist