Provider Demographics
NPI:1255778726
Name:SHUN, JOHN JINN-JYH (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JINN-JYH
Last Name:SHUN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4276
Mailing Address - Country:US
Mailing Address - Phone:310-323-2887
Mailing Address - Fax:310-323-8609
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4276
Practice Address - Country:US
Practice Address - Phone:310-323-2887
Practice Address - Fax:310-323-8609
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016667213E00000X
CAE5280213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist