Provider Demographics
NPI:1619902624
Name:SHIN, JAMES S (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S EUCLID ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802
Mailing Address - Country:US
Mailing Address - Phone:714-638-1347
Mailing Address - Fax:714-534-2098
Practice Address - Street 1:2100 S EUCLID ST
Practice Address - Street 2:SUITE #101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802
Practice Address - Country:US
Practice Address - Phone:714-638-1347
Practice Address - Fax:714-534-2098
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0251124Medicaid
ZZZ29510ZOtherBLUE SHIELD
CAW11568AMedicare ID - Type Unspecified
ZZZ29510ZOtherBLUE SHIELD
CA0251124Medicaid