Provider Demographics
NPI:1740595396
Name:PETER B. SHIN,M.D.,INC
Entity Type:Organization
Organization Name:PETER B. SHIN,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-326-2161
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:427
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4801
Mailing Address - Country:US
Mailing Address - Phone:310-326-2161
Mailing Address - Fax:310-534-5026
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:427
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4801
Practice Address - Country:US
Practice Address - Phone:310-326-2161
Practice Address - Fax:310-534-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46271261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A462710Medicaid
3901800001Medicare NSC
CAA46271Medicare PIN
CA00A462710Medicaid