Provider Demographics
NPI:1861479081
Name:SHIN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 S COURT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4929
Mailing Address - Country:US
Mailing Address - Phone:559-734-9244
Mailing Address - Fax:559-734-6932
Practice Address - Street 1:1700 S COURT ST
Practice Address - Street 2:SUITE F
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4929
Practice Address - Country:US
Practice Address - Phone:559-734-9244
Practice Address - Fax:559-734-6932
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4119174400000X
CAA699522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154388601Medicaid
TX8148B8Medicare ID - Type Unspecified
TXH65051Medicare UPIN