Provider Demographics
NPI:1821158668
Name:SHIN, JAMES JUNG HYUN (MS AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JUNG HYUN
Last Name:SHIN
Suffix:
Gender:M
Credentials:MS AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2699
Mailing Address - Country:US
Mailing Address - Phone:213-380-8618
Mailing Address - Fax:213-380-2091
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2699
Practice Address - Country:US
Practice Address - Phone:213-380-8618
Practice Address - Fax:213-380-2091
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4050237700000X
CAAU2108231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0021080Medicaid
CA1821158668Medicaid