Provider Demographics
NPI:1629549266
Name:SHIN, JUSTIN YOONSUP (DACM, LAC, MSC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:YOONSUP
Last Name:SHIN
Suffix:
Gender:M
Credentials:DACM, LAC, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 16TH ST APT 511
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3759
Mailing Address - Country:US
Mailing Address - Phone:703-347-1823
Mailing Address - Fax:
Practice Address - Street 1:77 BIRCH ST STE B
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1400
Practice Address - Country:US
Practice Address - Phone:415-763-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty