Provider Demographics
NPI:1841590304
Name:SHIN, ESTHER MIJUNG (DPT)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:MIJUNG
Last Name:SHIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 SAN RAMON VALLEY BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4032
Mailing Address - Country:US
Mailing Address - Phone:925-348-0224
Mailing Address - Fax:925-552-5787
Practice Address - Street 1:1099 CARRARA WAY
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6557
Practice Address - Country:US
Practice Address - Phone:925-980-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist